Risk factors and crucial prognostic indicators of mortality in liver transplant recipients with bloodstream infections: A comprehensives study of 1049 consecutive liver transplants over an 11-year period

IF 4.5 2区 医学 Q2 IMMUNOLOGY Journal of Microbiology Immunology and Infection Pub Date : 2024-06-20 DOI:10.1016/j.jmii.2024.06.002
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Abstract

Background

Liver transplantation (LT) is a pivotal treatment for end-stage liver disease. However, bloodstream infections (BSI) in the post-operative period present a significant threat to patient survival. This study aims to identify risk factors for post-LT BSI and crucial prognostic indicators for mortality among affected patients.

Methods

We conducted a retrospective study of adults diagnosed with end-stage liver disease who underwent their initial LT between 2010 and 2021. Those who developed BSI post-LT during the same hospital admission were classified into the BSI group.

Results

In this cohort of 1049 patients, 89 (8.4%) developed BSI post-LT, while 960 (91.5%) did not contract any infection. Among the BSI cases, 17 (19.1%) patients died. The average time to BSI onset was 48 days, with 46% occurring within the first month post-LT. Of the 123 isolated microorganisms, 97 (78.8%) were gram-negative bacteria. BSI patients had significantly longer stays in the intensive care unit and hospital compared to non-infected patients. The 90-day and in-hospital mortality rates for recipients with BSI were significantly higher than those without infections. Multivariate analysis indicated heightened BSI risk in patients with blood loss >3000 mL during LT (odds ratio [OR] 2.128), re-operation within 30 days (OR 2.341), post-LT bile leakage (OR 3.536), and graft rejection (OR 2.194). Additionally, chronic kidney disease (OR 6.288), each 1000 mL increase in intraoperative blood loss (OR 1.147) significantly raised mortality risk in BSI patients, whereas each 0.1 mg/dL increase in albumin levels correlated with a lower risk of death from BSI (OR 0.810).

Conclusions

This study underscores the need for careful monitoring and management in the post-LT period, especially for patients at higher risk of BSI. It also suggests that serum albumin levels could serve as a valuable prognostic indicator for outcomes in LT recipients experiencing BSI.

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肝移植受者血流感染的风险因素和重要预后指标:对 11 年间 1049 例连续肝移植手术的综合研究。
背景:肝移植(LT)是治疗终末期肝病的关键疗法。然而,术后血流感染(BSI)对患者的生存构成了重大威胁。本研究旨在确定肝移植术后 BSI 的风险因素以及影响患者死亡率的关键预后指标:我们对 2010 年至 2021 年间接受首次 LT 的终末期肝病成人患者进行了一项回顾性研究。在同一次住院期间,LT 后发生 BSI 的患者被归入 BSI 组:在这组1049名患者中,89人(8.4%)在LT术后发生了BSI,960人(91.5%)没有感染。在 BSI 病例中,17 例(19.1%)患者死亡。BSI 的平均发病时间为 48 天,46% 发生在 LT 后的第一个月内。在 123 种分离出的微生物中,97 种(78.8%)为革兰氏阴性菌。与非感染患者相比,BSI 患者在重症监护室和医院的住院时间明显更长。患有 BSI 的受助者的 90 天死亡率和住院死亡率明显高于未感染者。多变量分析表明,LT 期间失血量大于 3000 毫升(几率比 [OR] 2.128)、30 天内再次手术(OR 2.341)、LT 后胆漏(OR 3.536)和移植物排斥(OR 2.194)的患者发生 BSI 的风险更高。此外,慢性肾脏疾病(OR 6.288)、术中失血量每增加 1000 毫升(OR 1.147)都会显著增加 BSI 患者的死亡风险,而白蛋白水平每增加 0.1 毫克/分升就会降低 BSI 患者的死亡风险(OR 0.810):本研究强调了在 LT 术后需要仔细监测和管理,尤其是对 BSI 风险较高的患者。这项研究还表明,血清白蛋白水平可以作为一个有价值的预后指标,用于预测发生 BSI 的 LT 受者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Microbiology Immunology and Infection
Journal of Microbiology Immunology and Infection IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
15.90
自引率
5.40%
发文量
159
审稿时长
67 days
期刊介绍: Journal of Microbiology Immunology and Infection is an open access journal, committed to disseminating information on the latest trends and advances in microbiology, immunology, infectious diseases and parasitology. Article types considered include perspectives, review articles, original articles, brief reports and correspondence. With the aim of promoting effective and accurate scientific information, an expert panel of referees constitutes the backbone of the peer-review process in evaluating the quality and content of manuscripts submitted for publication.
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