Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?
Background/Aims Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. Methods Six hundred twenty consecutive HCV-related cirrhotic...
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| Format: | Article |
| Language: | English |
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Korean Association for the Study of the Liver
2019-09-01
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| Series: | Clinical and Molecular Hepatology |
| Subjects: | |
| Online Access: | http://e-cmh.org/upload/pdf/cmh-2018-0097.pdf |
| _version_ | 1828332954737180672 |
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| author | Elham Ahmed Hassan Abeer Sharaf El-Din Abdel Rehim Mohamed Omar Abdel-Malek Asmaa Omar Ahmed Nourhan Mahmoud Abbas |
| author_facet | Elham Ahmed Hassan Abeer Sharaf El-Din Abdel Rehim Mohamed Omar Abdel-Malek Asmaa Omar Ahmed Nourhan Mahmoud Abbas |
| author_sort | Elham Ahmed Hassan |
| collection | DOAJ |
| description | Background/Aims Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. Methods Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. Results Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. Conclusions Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care. |
| first_indexed | 2024-04-13T21:12:55Z |
| format | Article |
| id | doaj.art-0faeadc1d1ae4847b9659e9991edab0b |
| institution | Directory Open Access Journal |
| issn | 2287-2728 2287-285X |
| language | English |
| last_indexed | 2024-04-13T21:12:55Z |
| publishDate | 2019-09-01 |
| publisher | Korean Association for the Study of the Liver |
| record_format | Article |
| series | Clinical and Molecular Hepatology |
| spelling | doaj.art-0faeadc1d1ae4847b9659e9991edab0b2022-12-22T02:29:46ZengKorean Association for the Study of the LiverClinical and Molecular Hepatology2287-27282287-285X2019-09-0125331732510.3350/cmh.2018.00971469Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis?Elham Ahmed Hassan0Abeer Sharaf El-Din Abdel Rehim1Mohamed Omar Abdel-Malek2Asmaa Omar Ahmed3Nourhan Mahmoud Abbas4 Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt Department of Gastroenterology and Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, EgyptBackground/Aims Cellulitis is a common infection in patients with liver cirrhosis. We aimed to compare risk factors, microbial aspects, and outcomes of cellulitis in compensated and decompensated hepatitis C virus (HCV)-related cirrhosis. Methods Six hundred twenty consecutive HCV-related cirrhotic patients were evaluated for cellulitis. Demographic and clinical data were evaluated, along with blood and skin cultures. Severity of cirrhosis was assessed using Child-Pugh score. In-hospital mortality was assessed. Results Seventy-seven (12.4%) cirrhotic patients had cellulitis (25 with compensated and 52 with decompensated disease). Smoking and venous insufficiency were risk factors of cellulitis in compensated cirrhosis. Leg edema, ascites, hyperbilrubinemia and hypoalbuminemia were risk factors in decompensated cirrhosis. Gram-positive bacteria (Staphylococcus spp. and Streptococcus pyogenes) were the infective organisms in compensated patients, while gram negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) were the predominant organisms in decompensated cirrhosis. Fungi (Candida albicans and Aspergillus niger) were detected in 3 decompensated cases. In-hospital mortality in patients with cellulitis was 27.3%, approaching 100% in decompensated patients with gram-negative cellulitis. Prolonged hospitalization, higher model for end-stage liver disease (MELD)-Na score, septic shock, local complication, and recurrent cellulitis were predictors of mortality. Conclusions Cellulitis in compensated cirrhosis is different from that of decompensated patients regarding microorganisms, pathogenesis, and prognosis. Cellulitis has a poor prognosis, with mortality rates approaching 100% in decompensated patients with gram-negative cellulitis. Stratifying patients according to severity of cirrhosis is important to identify the proper empirical antibiotic and to decide the proper means of care.http://e-cmh.org/upload/pdf/cmh-2018-0097.pdfCellulitisLiver cirrhosisMortality |
| spellingShingle | Elham Ahmed Hassan Abeer Sharaf El-Din Abdel Rehim Mohamed Omar Abdel-Malek Asmaa Omar Ahmed Nourhan Mahmoud Abbas Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? Clinical and Molecular Hepatology Cellulitis Liver cirrhosis Mortality |
| title | Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? |
| title_full | Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? |
| title_fullStr | Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? |
| title_full_unstemmed | Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? |
| title_short | Are there differences in risk factors, microbial aspects, and prognosis of cellulitis between compensated and decompensated hepatitis C virus-related cirrhosis? |
| title_sort | are there differences in risk factors microbial aspects and prognosis of cellulitis between compensated and decompensated hepatitis c virus related cirrhosis |
| topic | Cellulitis Liver cirrhosis Mortality |
| url | http://e-cmh.org/upload/pdf/cmh-2018-0097.pdf |
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