Infection is a precipitating factor for hepatic encephalopathy (HE). But whether HE increases the risk of infection during hospitalization is still uncertain. This was the objective of this study, which also examined the association of infection with short-term mortality in patients with overt hepatic encephalopathy (OHE). Seven hundred and fifty-nine patients with cirrhosis who had been hospitalized with acute decompensation were enrolled for the study using prospectively maintained clinical databases at two hospitals. Baseline infection and HE data was gathered; occurrence of new “de novo” infections and mortality within 28 days were evaluated. 

Patients were categorized into four groups: no baseline OHE or infection, OHE with no baseline Infection, no OHE but baseline infection and OHE with baseline infection. On multivariate analyses, OHE and admission to Intensive Therapy Unit (ITU) were the factors predictive of de novo infection with odds ratio of 1.5 and 2.3 respectively. Patients with OHE and baseline infection had the highest 28-day mortality (72%) followed by OHE with no baseline infection (60.2%), no OHE but baseline infection (55.0%), while the mortality was lowest in patient with no baseline OHE or infection (25.3%). Age, INR (international normalized ratio) and creatinine were independent predictors of mortality. A significant association was noted between presence of overt HE, infection, coagulation and multiorgan failure with increased mortality. Thus, OHE can be regarded as an independent risk factor for de novo infection in acute decompensated cirrhotic patients.

Source: Alabsawy E, et al. Aliment Pharmacol Ther. 2022 Mar;55(6):722-732.