Bacterial and fungal infections: a frequent and deadly complication among critically ill acute liver failure patients

Abstract

Background

Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients’ prognosis remain poorly explored.

Methods

We conducted a retrospective single-centre study on patients admitted for ALF to the ICU of a referral University Hospital from 2000 to 2021. Baseline characteristics and outcomes according to the presence of infection until day 28 were analysed. Risk factors for infection were determined using logistic regression. The impact of infection on 28-day survival was assessed using the proportional hazard Cox model.

Results

Of the 194 patients enrolled, 79 (40.7%) underwent infection: community-acquired, hospital-acquired before ICU and ICU-acquired before/without and after transplant in 26, 23, 23 and 14 patients, respectively. Most infections were pneumonia (41.4%) and bloodstream infection (38.8%). Of a total of 130 microorganisms identified, 55 were Gram-negative bacilli (42.3%), 48 Gram-positive cocci (36.9%) and 21 were fungi (16.2%). Obesity (OR 3.77 [95% CI 1.18–14.40]; p = .03) and initial mechanical ventilation (OR 2.26 [95% CI 1.25–4.12]; p = .007) were independent factors associated with overall infection. SAPSII > 37 (OR 3.67 [95% CI 1.82–7.76], p < .001) and paracetamol aetiology (OR 2.10 [95% CI 1.06–4.22], p = .03) were independently associated with infection at admission to ICU. On the opposite, paracetamol aetiology was associated with lower risk of ICU-acquired infection (OR 0.37 [95% CI 0.16–0.81], p = .02). Patients with any type of infection had lower day 28 survival rates (57% versus 73%; HR 1.65 [1.01–2.68], p = .04). The presence of infection at ICU admission (p = .04), but not ICU-acquired infection, was associated with decreased survival.

Conclusions

The prevalence of infection is high in ALF patients which is associated with a higher risk of death. Further studies assessing the use of early antimicrobial therapy are needed.

Keywords:

• Acute liver failure
•   infectious events

Acknowledgements

The authors thank Gabriel Auger, Adrien Turban and Jean-Pierre Gangneux for their help during the analysis and acquisition of the microbiological data.

Ethical approval

This study conforms to the principles outlined in the Declaration of Helsinki and was approved by Ethics Committee of the Rennes University Hospital received approval by the Ethics Committee of Rennes University Hospital (no. 21.83).

Author contributions

F.B., F.R. and CC conceived, designed, coordinated the data collection and supervised the study. F.B., K.P., V.C., F.D., B.P., M.L., A.M., P.G., Q.Q., P.H., K.B., C.C. and F.R. participated to the data collection and the management of the patients. F.B., F.R. and C.C. interpreted the data. F.R., C.C. and E.L.P. performed the statistical analysis. F.B., F.R. and C.C. wrote the first draft of the article. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets from this study are available from the corresponding author on request.