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Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort)

Pierre Nahon 1, 2, * Mathilde Lescat 3, 4 Richard Layese Valérie Bourcier 5 Nabila Talmat Setty Allam Patrick Marcellin 6 Dominique Guyader 7, 8 Stanislas Pol 9 Dominique Larrey 10, 11 Victor de Lédinghen Denis Ouzan Fabien Zoulim 12, 13 Dominique Roulot 14 Albert Tran 15, 16 Jean-Pierre Bronowicki 17, 18 Jean-Pierre Zarski 19 Odile Goria 20 Paul Calès 21 Jean-Marie Peron 22 Laurent Alric 23 Marc Bourlière 24 Philippe Mathurin 25 Jean-Frederic Blanc 26, 27 Armand Abergel 28 Lawrence Serfaty 29 Ariane Mallat 30, 31 Jean-Didier Grangé Pierre Attali 32 Yannick Bacq 33 Claire Wartelle Thong Dao 34, 35 Yves Benhamou 36 Christophe Pilette Christine Silvain 37 Christos Christidis Dominique Capron 38 Brigitte Bernard-Chabert Sophie Hillaire Vincent Di Martino Jean-Claude Trinchet 5 Richard Moreau 39 Françoise Roudot-Thoraval 30, 40
* Corresponding author
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\textless0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p\textless0.001). 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
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Submitted on : Friday, November 6, 2015 - 11:31:00 AM
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Pierre Nahon, Mathilde Lescat, Richard Layese, Valérie Bourcier, Nabila Talmat, et al.. Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort). Gut, BMJ Publishing Group, 2017, 66 (2), pp.330-341. ⟨10.1136/gutjnl-2015-310275⟩. ⟨hal-01225507⟩



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