Pierre Nahon1, Mathilde Lescat2, Richard Layese3, Valérie Bourcier1, Nabila Talmat1, Setty Allam4, Patrick Marcellin5, Dominique Guyader6, Stanislas Pol7, Dominique Larrey8, Victor De Lédinghen9, Denis Ouzan10, Fabien Zoulim11, Dominique Roulot12, Albert Tran13, Jean-Pierre Bronowicki14, Jean-Pierre Zarski15, Odile Goria16, Paul Calès17, Jean-Marie Péron18, Laurent Alric19, Marc Bourlière20, Philippe Mathurin21, Jean-Frédéric Blanc22, Armand Abergel23, Lawrence Serfaty24, Ariane Mallat25, Jean-Didier Grangé26, Pierre Attali27, Yannick Bacq28, Claire Wartelle29, Thông Dao30, Yves Benhamou31, Christophe Pilette32, Christine Silvain33, Christos Christidis34, Dominique Capron35, Brigitte Bernard-Chabert36, Sophie Hillaire37, Vincent Di Martino38, Jean-Claude Trinchet1, Richard Moreau5, Françoise Roudot-Thoraval3 for the ANRS CO12 CirVir and Microcir Groups
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Author Affiliations
1AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris, France
2AP-HP, Hôpital Jean Verdier, Service de Microbiologie, Bondy, Université Paris 13, Bobigny, et INSERM UMR 1139, Paris, France
3AP-HP, Hôpital Henri Mondor, Département de Santé Publique, Créteil, France
4Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
5AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
6CHU Pontchaillou, Service d'Hépatologie, Rennes, France
7AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris, France
8Hôpital Saint Eloi, Service d'Hépatologie, Montpellier, France
9Hôpital Haut-Lévêque, Service d'Hépatologie, Bordeaux, France
10Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
11Hôpital Hôtel Dieu, Service d'Hépatologie, Lyon, France
12AP-HP, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
13CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
14Hôpital Brabois, Service d'Hépatologie, Vandoeuvre-les-Nancy, France
15Hôpital Michallon, Service d'Hépatologie, Grenoble, France
16Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
17CHU d'Angers, Service d'Hépatologie, Angers, France
18Hôpital Purpan, Service d'Hépatologie, Toulouse, France
19CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
20Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
21Hôpital Claude Huriez, Service d'Hépatologie, Lille, France
22Hôpital St André, Service d'Hépatologie, Bordeaux, France
23Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
24AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
25AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
26AP-HP, Hôpital Tenon, Service d'Hépatologie, Paris, France
27AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
28Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, Tours, France
29Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
30Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
31AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
32CHU Le Mans, Service d'Hépatologie, Le Mans, France
33CHU de Poitiers, Service d'Hépatologie, Poitiers, France
34Institut Mutualiste Montsouris, Service d'Hépatologie, Paris, France
35Hôpital Amiens Nord, Service d'Hépatologie, Amiens, France
36Hôpital Robert Debré, Service d'Hépatologie, Reims, France
37Hôpital Foch, Service d'Hépatologie, Suresnes, France
38Hôpital Jean Minjoz, Service d'Hépatologie, Besançon, France
Correspondence to Dr Pierre Nahon, Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, Bondy 93140, France; [email protected]
Received 1 July 2015
Revised 27 September 2015
Accepted 29 September 2015
Published Online First 28 October 2015
Abstract
Objective To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis.
Design This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child–Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework.
Results 1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control.
Conclusion BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.