A retrospective study has identified factors indicative of risk of infection in patients hospitalized with alcohol-associated hepatitis in two tertiary care centers in the United States.¹

The multicenter study examined 286 patients with alcohol-associated hepatitis hospitalized from 1998 to 2018 at the Mayo Clinic in Rochester (n=193) and Virginia Commonwealth University in Richmond (n=96). The overall infection rate was found to be 24%. Thirty-one (46%) of these patients developed infections during their hospital stay, while 37 (54%) developed infections after they were discharged from the hospital; 34 (33%) patients had infection (community-acquired) before their hospital admission.

For the study, a hospital-acquired infection was defined as infection that occurred 48 hours after admission until the discharge date, while posthospital infections were categorised as infections that occurred up to 6 months after the discharge. A community-acquired infection was one that occurred up to 48 hours after admission.

The nosocomial or in-hospital infections that occurred were lower respiratory tract infections, urinary tract infections, bloodstream infections, spontaneous bacterial peritonitis and Clostridium difficile infections.

Infections that developed within 6 months of discharge from the hospital included UTIs, spontaneous bacterial peritonitis, lower respiratory tract infections, bloodstream infections and C. difficile infections.

Analysis of outcomes showed that ascites at the time of admission (HR 2.06) and steroids (HR 1.70) were most predictive of risk of bacterial infections. Higher Model for End-Stage Liver Disease (MELD) scores (HR 1.05 per point) and white blood cell count (WBC) (HR 1.02 per unit) were also found to be significant risk factors of infection. Mortality was higher in patients with infections that occurred after discharge (HR 4.27).

Regular monitoring will help to identify patients with alcohol-associated hepatitis at high risk of infection, which followed by early intervention will result in better clinical outcomes.

The study is published in Hepatology Communications.

Reference

1. Penrice DD, et al. Risk prediction of nosocomial and posthospital discharge infections in alcohol-associated hepatitis. Hepatol Communi. 28 July 2021. https://doi.org/10.1002/hep4.1786.