Pub Date : 2024-11-06DOI: 10.1016/s2468-1253(24)00347-9
Gamal Shiha, Ahmed Farahat, Ibrahim Adamu Alhassan, Ruth Bello Dalhatu Araf, Riham Soliman
No Abstract
无摘要
{"title":"A model to achieve microelimination of viral hepatitis in Shabo village, Nasarawa state, Nigeria","authors":"Gamal Shiha, Ahmed Farahat, Ibrahim Adamu Alhassan, Ruth Bello Dalhatu Araf, Riham Soliman","doi":"10.1016/s2468-1253(24)00347-9","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00347-9","url":null,"abstract":"No Abstract","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"140 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/s2468-1253(24)00357-1
Holly Baker
<h2>Section snippets</h2><section><section><h2>Tranexamic acid not recommended for liver cancer surgery</h2>Tranexamic acid does not reduce bleeding and increases major complications in liver cancer surgery, according to new findings from the <span><span>HeLiX trial</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>. Paul Karanicolas and colleagues randomly assigned patients undergoing liver resection for cancer to receive either tranexamic acid (n=619) or matching placebo (n=626) beginning at induction of anaesthesia. The primary outcome—receipt of a red blood cell transfusion within 7 days of surgery—occurred in 101 (16%) patients in the tranexamic acid group</section></section><section><section><h2>Oral microbiome therapeutic for recurrent <em>C difficile</em></h2><span><span>CP101</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, an oral microbiome therapeutic, restores microbiome diversity and offers a safe effective treatment option for recurrent <em>C difficile</em> infections, according to a phase 2 trial. Jessica Allegretti and colleagues randomly assigned participants with recurrent <em>C difficile</em> to receive a single oral dose of either CP101 (n=102) or placebo (n=96) after standard-of-care antibiotics. At week 8, a significantly higher proportion of participants in the CP101 group achieved had not had <em>C difficile</em></section></section><section><section><h2>Liver transplantation for inoperative colorectal liver metastases</h2>Long-term survival is possible after liver transplant for colorectal liver metastases, according to the <span><span>TransMet trial</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>. René Adam and colleagues randomly assigned patients with permanently unresectable colorectal liver metastases to receive liver transplantation plus chemotherapy (n=47) or chemotherapy alone (n=47). The per-protocol population of patients who received the assigned treatment included 36 patients in liver transplantation plus chemotherapy group and 38 in the chemotherapy alone</section></section><section><section><h2><span><span>Palliative radiotherapy</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span> for hepatic cancer</h2>Low-dose liver radiotherapy improves pain in patients receiving palliative care for hepatic cancer, a phase 3 trial suggests. Laura Dawson and colleagues randomly assigned
{"title":"Research in Brief","authors":"Holly Baker","doi":"10.1016/s2468-1253(24)00357-1","DOIUrl":"https://doi.org/10.1016/s2468-1253(24)00357-1","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Tranexamic acid not recommended for liver cancer surgery</h2>Tranexamic acid does not reduce bleeding and increases major complications in liver cancer surgery, according to new findings from the <span><span>HeLiX trial</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>. Paul Karanicolas and colleagues randomly assigned patients undergoing liver resection for cancer to receive either tranexamic acid (n=619) or matching placebo (n=626) beginning at induction of anaesthesia. The primary outcome—receipt of a red blood cell transfusion within 7 days of surgery—occurred in 101 (16%) patients in the tranexamic acid group</section></section><section><section><h2>Oral microbiome therapeutic for recurrent <em>C difficile</em></h2><span><span>CP101</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, an oral microbiome therapeutic, restores microbiome diversity and offers a safe effective treatment option for recurrent <em>C difficile</em> infections, according to a phase 2 trial. Jessica Allegretti and colleagues randomly assigned participants with recurrent <em>C difficile</em> to receive a single oral dose of either CP101 (n=102) or placebo (n=96) after standard-of-care antibiotics. At week 8, a significantly higher proportion of participants in the CP101 group achieved had not had <em>C difficile</em></section></section><section><section><h2>Liver transplantation for inoperative colorectal liver metastases</h2>Long-term survival is possible after liver transplant for colorectal liver metastases, according to the <span><span>TransMet trial</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>. René Adam and colleagues randomly assigned patients with permanently unresectable colorectal liver metastases to receive liver transplantation plus chemotherapy (n=47) or chemotherapy alone (n=47). The per-protocol population of patients who received the assigned treatment included 36 patients in liver transplantation plus chemotherapy group and 38 in the chemotherapy alone</section></section><section><section><h2><span><span>Palliative radiotherapy</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> for hepatic cancer</h2>Low-dose liver radiotherapy improves pain in patients receiving palliative care for hepatic cancer, a phase 3 trial suggests. Laura Dawson and colleagues randomly assigned","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":"91 1","pages":""},"PeriodicalIF":35.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142594283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-02DOI: 10.1016/S2468-1253(24)00200-0
Matthew C Choy, Christopher F D Li Wai Suen, Danny Con, Kristy Boyd, Raquel Pena, Kathryn Burrell, Ourania Rosella, David Proud, Richard Brouwer, Alexandra Gorelik, Danny Liew, William R Connell, Emily K Wright, Kirstin M Taylor, Aviv Pudipeddi, Michelle Sawers, Britt Christensen, Watson Ng, Jakob Begun, Graham Radford-Smith, Mayur Garg, Neal Martin, Daniel R van Langenberg, Nik S Ding, Lauren Beswick, Rupert W Leong, Miles P Sparrow, Peter De Cruz
<p><strong>Background: </strong>The optimal dosing strategy for infliximab in steroid-refractory acute severe ulcerative colitis (ASUC) is unknown. We compared intensified and standard dose infliximab rescue strategies and explored maintenance therapies following infliximab induction in ASUC.</p><p><strong>Methods: </strong>In this open-label, multicentre, randomised controlled trial, patients aged 18 years or older from 13 Australian tertiary hospitals with intravenous steroid-refractory ASUC were randomly assigned (1:2) to receive a first dose of 10 mg/kg infliximab or 5 mg/kg infliximab (randomisation 1). Block randomisation was used and stratified by history of thiopurine exposure and study site, with allocation concealment maintained via computer-generated randomisation. Patients in the 10 mg/kg group (intensified induction strategy [IIS]) received a second dose at day 7 or earlier at the time of non-response; all patients in the 5 mg/kg group were re-randomised between day 3 and day 7 (1:1; randomisation 2) to a standard induction strategy (SIS) or accelerated induction strategy (AIS), resulting in three induction groups. Patients in the SIS group received 5 mg/kg infliximab at weeks 0, 2, and 6, with an extra 5 mg/kg dose between day 3 and day 7 if no response. Patients in the AIS group received 5 mg/kg infliximab at weeks 0, 1, and 3, with the week 1 dose increased to 10 mg/kg and given between day 3 and day 7 if no response. The primary outcome was clinical response by day 7 (reduction in Lichtiger score to <10 with a decrease of ≥3 points from baseline, improvement in rectal bleeding, and decreased stool frequency to ≤4 per day). Secondary endpoints assessed outcomes to day 7 and exploratory outcomes compared induction regimens until month 3. From month 3, maintenance therapy was selected based on treatment experience, with use of thiopurine monotherapy, combination infliximab and thiopurine, or infliximab monotherapy, with follow-up as a cohort study up to month 12. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02770040, and is completed.</p><p><strong>Findings: </strong>Between July 20, 2016, and Sept 24, 2021, 138 patients were randomly assigned (63 [46%] female and 75 [54%] male); 46 received a first dose of 10 mg/kg infliximab and 92 received 5 mg/kg infliximab. After randomisation 1, we observed no significant difference in the proportion of patients who had a clinical response by day 7 between the 10 mg/kg and 5 mg/kg groups (30 [65%] of 46 vs 56 [61%] of 92, p=0·62; risk ratio adjusted for thiopurine treatment history, 1·06 [95% CI 0·94-1·20], p=0·32). We found no significant differences in secondary endpoints including time to clinical response or change in Lichtiger score from baseline to day 7. Two patients who received 10 mg/kg infliximab underwent colectomy in the first 7 days compared with no patients in the 5 mg/kg group (p=0·21). Three serious adverse events occurred in three pa
{"title":"Intensified versus standard dose infliximab induction therapy for steroid-refractory acute severe ulcerative colitis (PREDICT-UC): an open-label, multicentre, randomised controlled trial.","authors":"Matthew C Choy, Christopher F D Li Wai Suen, Danny Con, Kristy Boyd, Raquel Pena, Kathryn Burrell, Ourania Rosella, David Proud, Richard Brouwer, Alexandra Gorelik, Danny Liew, William R Connell, Emily K Wright, Kirstin M Taylor, Aviv Pudipeddi, Michelle Sawers, Britt Christensen, Watson Ng, Jakob Begun, Graham Radford-Smith, Mayur Garg, Neal Martin, Daniel R van Langenberg, Nik S Ding, Lauren Beswick, Rupert W Leong, Miles P Sparrow, Peter De Cruz","doi":"10.1016/S2468-1253(24)00200-0","DOIUrl":"10.1016/S2468-1253(24)00200-0","url":null,"abstract":"<p><strong>Background: </strong>The optimal dosing strategy for infliximab in steroid-refractory acute severe ulcerative colitis (ASUC) is unknown. We compared intensified and standard dose infliximab rescue strategies and explored maintenance therapies following infliximab induction in ASUC.</p><p><strong>Methods: </strong>In this open-label, multicentre, randomised controlled trial, patients aged 18 years or older from 13 Australian tertiary hospitals with intravenous steroid-refractory ASUC were randomly assigned (1:2) to receive a first dose of 10 mg/kg infliximab or 5 mg/kg infliximab (randomisation 1). Block randomisation was used and stratified by history of thiopurine exposure and study site, with allocation concealment maintained via computer-generated randomisation. Patients in the 10 mg/kg group (intensified induction strategy [IIS]) received a second dose at day 7 or earlier at the time of non-response; all patients in the 5 mg/kg group were re-randomised between day 3 and day 7 (1:1; randomisation 2) to a standard induction strategy (SIS) or accelerated induction strategy (AIS), resulting in three induction groups. Patients in the SIS group received 5 mg/kg infliximab at weeks 0, 2, and 6, with an extra 5 mg/kg dose between day 3 and day 7 if no response. Patients in the AIS group received 5 mg/kg infliximab at weeks 0, 1, and 3, with the week 1 dose increased to 10 mg/kg and given between day 3 and day 7 if no response. The primary outcome was clinical response by day 7 (reduction in Lichtiger score to <10 with a decrease of ≥3 points from baseline, improvement in rectal bleeding, and decreased stool frequency to ≤4 per day). Secondary endpoints assessed outcomes to day 7 and exploratory outcomes compared induction regimens until month 3. From month 3, maintenance therapy was selected based on treatment experience, with use of thiopurine monotherapy, combination infliximab and thiopurine, or infliximab monotherapy, with follow-up as a cohort study up to month 12. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02770040, and is completed.</p><p><strong>Findings: </strong>Between July 20, 2016, and Sept 24, 2021, 138 patients were randomly assigned (63 [46%] female and 75 [54%] male); 46 received a first dose of 10 mg/kg infliximab and 92 received 5 mg/kg infliximab. After randomisation 1, we observed no significant difference in the proportion of patients who had a clinical response by day 7 between the 10 mg/kg and 5 mg/kg groups (30 [65%] of 46 vs 56 [61%] of 92, p=0·62; risk ratio adjusted for thiopurine treatment history, 1·06 [95% CI 0·94-1·20], p=0·32). We found no significant differences in secondary endpoints including time to clinical response or change in Lichtiger score from baseline to day 7. Two patients who received 10 mg/kg infliximab underwent colectomy in the first 7 days compared with no patients in the 5 mg/kg group (p=0·21). Three serious adverse events occurred in three pa","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"981-996"},"PeriodicalIF":30.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-05DOI: 10.1016/S2468-1253(24)00266-8
Nipun Verma, Salvatore Piano
{"title":"Regional disparities of infections in cirrhosis: a call for action.","authors":"Nipun Verma, Salvatore Piano","doi":"10.1016/S2468-1253(24)00266-8","DOIUrl":"10.1016/S2468-1253(24)00266-8","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"967-969"},"PeriodicalIF":30.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-02DOI: 10.1016/S2468-1253(24)00229-2
Saurabh Kedia, Vineet Ahuja
{"title":"Infliximab rescue therapy in acute severe ulcerative colitis: more does not equal better.","authors":"Saurabh Kedia, Vineet Ahuja","doi":"10.1016/S2468-1253(24)00229-2","DOIUrl":"10.1016/S2468-1253(24)00229-2","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"966-967"},"PeriodicalIF":30.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-03DOI: 10.1016/S2468-1253(24)00220-6
Jeffrey V Lazarus, Henry E Mark, Naim Alkhouri, Luis Antonio Díaz, Ajay Duseja, C Wendy Spearman, Maja Thiele, Vincent Wai-Sun Wong, Zobair M Younossi
{"title":"Best buy interventions to address the burden of steatotic liver disease.","authors":"Jeffrey V Lazarus, Henry E Mark, Naim Alkhouri, Luis Antonio Díaz, Ajay Duseja, C Wendy Spearman, Maja Thiele, Vincent Wai-Sun Wong, Zobair M Younossi","doi":"10.1016/S2468-1253(24)00220-6","DOIUrl":"10.1016/S2468-1253(24)00220-6","url":null,"abstract":"","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"975-977"},"PeriodicalIF":30.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-09-05DOI: 10.1016/S2468-1253(24)00224-3
Zhujun Cao, Florence Wong, Ashok K Choudhury, Patrick S Kamath, Mark Topazian, Aldo Torre, Peter C Hayes, Jacob George, Ramazan Idilman, Wai-Kay Seto, Hailemichael Desalegn, Mario Reis Alvares-da-Silva, Brian J Bush, Leroy R Thacker, Qing Xie, Jasmohan S Bajaj
<p><strong>Background: </strong>Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis.</p><p><strong>Methods: </strong>In this prospective cohort study initiated by the CLEARED Consortium, we enrolled adults (aged >18 years) with cirrhosis who were non-electively admitted to 98 hospitals from 26 countries or regions across six continents between Nov 5, 2021, and Dec 10, 2022. Data at admission, during hospitalisation, and for 30 days after discharge were collected through patient reports and chart reviews. Collected data included demographics; country and country income level per World Bank classifications (high-income countries [HICs], upper-middle-income countries [UMICs], and low-income or lower-middle-income countries [L-LMICs]); comorbidities; characteristics related to cirrhosis and the infections, including types, culture results, and drug resistance profile; antibiotic use; and disease course while hospitalised and for 30 days post-discharge. The primary outcome was in-hospital death or hospice referral in those with versus those without an admission infection (defined by the presence of infection on or within 48 h of admission). Multivariable log-binomial regression for in-hospital death or hospice referral was performed to identify risk factors.</p><p><strong>Findings: </strong>Of 4550 patients screened, 4238 patients (mean age 56·1 years [SD 13·3]; 2711 [64·0%] male and 1527 [36·0%] female) with complete data were enrolled. 1351 (31·9%) had admission infections. A higher proportion of patients in L-LMICs had infections (318 [41·7%] of 762 vs 444 [58·3%] without infection) than in UMICs (588 [30·6%] of 1922 vs 1334 [69·4%]) or HICs (445 [28·6%] of 1554 vs 1109 [71·4%]). Patients with admission infections had worse severity of cirrhosis and were more likely to have had an infection or been hospitalised in the preceding 6 months. The most common specific infection types were spontaneous bacterial peritonitis (391 [28·9%] of 1351), pneumonia (233 [17·2%]), and urinary tract infections (193 [14·3%]). 549 (40·6%) patients were culture-positive for bacterial or fungal infections, with the lowest culture-positive rates in Africa and mainland China. Most of the isolated organisms were Gram-negative (345 [63%] of 549), then Gram-positive (157 [29%]), and then fungi or mixed (47 [9%]), with Escherichia coli, Klebsiella pneumoniae, and Enterococcus spp being the top three isolated pathogens. The overall rate of drug resistance was 40% (220 of 549 with positive cultures), being highest in UMICs. The most used empirical antimicrobials were third-generation cephalosporins (453 [37%] of 1241), followed by the broad-spectrum β-lactams and β-lactamase inhibitors (289 [23%]). De-escalation was observed in 62 (20%) of 304 patients who had their antibiotics changed. Patients with versus without admiss
{"title":"Global prevalence and characteristics of infections and clinical outcomes in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium.","authors":"Zhujun Cao, Florence Wong, Ashok K Choudhury, Patrick S Kamath, Mark Topazian, Aldo Torre, Peter C Hayes, Jacob George, Ramazan Idilman, Wai-Kay Seto, Hailemichael Desalegn, Mario Reis Alvares-da-Silva, Brian J Bush, Leroy R Thacker, Qing Xie, Jasmohan S Bajaj","doi":"10.1016/S2468-1253(24)00224-3","DOIUrl":"10.1016/S2468-1253(24)00224-3","url":null,"abstract":"<p><strong>Background: </strong>Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis.</p><p><strong>Methods: </strong>In this prospective cohort study initiated by the CLEARED Consortium, we enrolled adults (aged >18 years) with cirrhosis who were non-electively admitted to 98 hospitals from 26 countries or regions across six continents between Nov 5, 2021, and Dec 10, 2022. Data at admission, during hospitalisation, and for 30 days after discharge were collected through patient reports and chart reviews. Collected data included demographics; country and country income level per World Bank classifications (high-income countries [HICs], upper-middle-income countries [UMICs], and low-income or lower-middle-income countries [L-LMICs]); comorbidities; characteristics related to cirrhosis and the infections, including types, culture results, and drug resistance profile; antibiotic use; and disease course while hospitalised and for 30 days post-discharge. The primary outcome was in-hospital death or hospice referral in those with versus those without an admission infection (defined by the presence of infection on or within 48 h of admission). Multivariable log-binomial regression for in-hospital death or hospice referral was performed to identify risk factors.</p><p><strong>Findings: </strong>Of 4550 patients screened, 4238 patients (mean age 56·1 years [SD 13·3]; 2711 [64·0%] male and 1527 [36·0%] female) with complete data were enrolled. 1351 (31·9%) had admission infections. A higher proportion of patients in L-LMICs had infections (318 [41·7%] of 762 vs 444 [58·3%] without infection) than in UMICs (588 [30·6%] of 1922 vs 1334 [69·4%]) or HICs (445 [28·6%] of 1554 vs 1109 [71·4%]). Patients with admission infections had worse severity of cirrhosis and were more likely to have had an infection or been hospitalised in the preceding 6 months. The most common specific infection types were spontaneous bacterial peritonitis (391 [28·9%] of 1351), pneumonia (233 [17·2%]), and urinary tract infections (193 [14·3%]). 549 (40·6%) patients were culture-positive for bacterial or fungal infections, with the lowest culture-positive rates in Africa and mainland China. Most of the isolated organisms were Gram-negative (345 [63%] of 549), then Gram-positive (157 [29%]), and then fungi or mixed (47 [9%]), with Escherichia coli, Klebsiella pneumoniae, and Enterococcus spp being the top three isolated pathogens. The overall rate of drug resistance was 40% (220 of 549 with positive cultures), being highest in UMICs. The most used empirical antimicrobials were third-generation cephalosporins (453 [37%] of 1241), followed by the broad-spectrum β-lactams and β-lactamase inhibitors (289 [23%]). De-escalation was observed in 62 (20%) of 304 patients who had their antibiotics changed. Patients with versus without admiss","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":"997-1009"},"PeriodicalIF":30.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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