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

Pierre Nahon (1, 2) , Mathilde Lescat (3, 2) , Richard Layese (4) , Valérie Bourcier (2) , Nabila Talmat (2) , Setty Allam (5) , Patrick Marcellin (6, 7) , Dominique Guyader (8, 9) , Stanislas Pol (10) , Dominique Larrey (11, 12, 13) , Victor de Lédinghen (14) , Denis Ouzan (15) , Fabien Zoulim (16, 17) , Dominique Roulot (18) , Albert Tran (19, 20) , Jean-Pierre Bronowicki (21, 22) , Jean-Pierre Zarski (23) , Odile Goria (24) , Paul Calès (25) , Jean-Marie Peron (26) , Laurent Alric (27) , Marc Bourlière (28) , Philippe Mathurin (29) , Jean-Frederic Blanc (30) , Armand Abergel (31) , Lawrence Serfaty (32) , Ariane Mallat (33, 34) , Jean-Didier Grangé (35) , Pierre Attali (36) , Yannick Bacq (37) , Claire Wartelle (38) , Thong Dao (39, 40) , Yves Benhamou (41) , Christophe Pilette (42) , Christine Silvain (43) , Christos Christidis (44) , Dominique Capron (45) , Brigitte Bernard-Chabert (46) , Sophie Hillaire (47) , Vincent Di Martino (48) , Jean-Claude Trinchet (2) , Richard Moreau (49) , Françoise Roudot-Thoraval (33, 50) , Anrs Co12 Cirvir Group

1 CRB3 - Centre de recherche biomédicale Bichat-Beaujon
2 Hôpital Jean Verdier [AP-HP]
3 U1139 - Physiopathologie et Pharmacotoxicologie Placentaire Humaine
4 Hôpital Henri Mondor
5 ANRS - Agence Nationale de Recherches sur le Sida et les Hépatites Virales
6 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
7 Service d’Hépatologie [Hôpital Beaujon]
8 Foie, métabolismes et cancer
9 CHU Pontchaillou [Rennes]
10 Hôpital Cochin [AP-HP]
11 Cellules souches normales et cancéreuses
12 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
13 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
14 Hôpital Haut-Lévêque [CHU Bordeaux]
15 Institut Arnault Tzanck
16 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
17 HCL - Hospices Civils de Lyon
18 Service de Gastro-entérologie [Avicenne]
19 C3M - Centre méditerranéen de médecine moléculaire
20 CHU Nice - Centre Hospitalier Universitaire de Nice
21 Service d'Hépato-gastro-entérologie [CHRU Nancy]
22 NGERE - Nutrition-Génétique et Exposition aux Risques Environnementaux
23 Département d'hépato-gastroentérologie
24 CHU Rouen
25 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
26 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
27 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement
28 Hôpital Saint-Joseph [Marseille]
29 Hôpital Claude Huriez [Lille]
30 Hôpital Saint-André
31 Hôpital Hôtel-Dieu de Clermont-Ferrand
32 CHU Saint-Antoine [AP-HP]
33 IMRB - Institut Mondor de Recherche Biomédicale
34 Service d'hépato-gastro-entérologie [APHP Henri Mondor]
35 CHU Tenon [AP-HP]
36 Hôpital Paul Brousse
37 Service de gastro-entérologie [CHU Trousseau]
38 CHIAP - Centre Hospitalier d'Aix en Provence [Aix-en-Provence]
39 Service d'Hépato-Gastro-Enterologie et Nutrition [CHU Caen]
40 COMETE - Mobilités : Vieillissement, Pathologie, Santé
41 Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière]
42 Centre Hospitalier Le Mans (CH Le Mans)
43 Hôpital de la Milétrie
44 IMM - Institut mutualiste Monsouris
45 CHU Amiens-Picardie
46 Hôpital Robert Debré
47 Hôpital Foch [Suresnes]
48 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
49 Hôpital Beaujon
50 Service de santé publique [Mondor]

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

Keywords: Hepatitis B; HEPATITIS C; BACTERIAL INFECTION; cirrhosis

Domains: Life Sciences [q-bio]; Microbiology and Parasitology; Life Sciences [q-bio]; Human health and pathology; Hépatology and Gastroenterology

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, 2017, 66 (2), pp.330-341. ⟨10.1136/gutjnl-2015-310275⟩. ⟨hal-01225507⟩