Evaluation of prognostic scoring systems in liver cirrhosis patients with bloodstream infection

Abstract

Patients with cirrhosis are at increased risk of developing bloodstream infections (BSIs), and the short-term mortality rate in those patients is high. The aim of this study was to compare the different scoring models to predict mortality in cirrhotic patients with BSIs. A total of 222 cirrhotic patients with BSIs were retrospectively included in the study. The demographic, clinical, and microbiologic data were collected and patients were followed for at least 28 days after blood cultures were established. A multivariable Cox proportional hazard model was used to identify independent risk factors for 28-day all-cause mortality. The prognostic accuracy of different scoring models (chronic liver failure-organ failure [CLIF-OF], model for end-stage liver disease [MELD], systemic inflammatory response syndrome [SIRS], and Pitt scores) were compared with the C-index and receiver operating characteristic curve (ROC). Forty deaths were recorded on day 28 after blood cultures were established. Male sex (hazard ratio [HR] = 2.75, 95% confidence interval [CI] = 1.10-6.86), international normalized ratio (INR) (HR = 1.76, 95% CI = 1.35-2.30), serum bilirubin (HR = 1.002, 95% CI = 1.000-1.003), circulation failure (HR = 3.56, 95% CI = 1.63-7.79), lung failure (HR = 2.23, 95% CI = 1.09-4.57), and non-primary BSI source (HR = 2.27, 95% CI = 1.09-4.73) were identified as independent risk factors for mortality in cirrhotic patients with BSIs. In predicting 28-day mortality, CLIF-OF and MELD scores had significantly high C-indices (0.79 and 0.76, respectively) and ROC values (0.786 and 0.782, respectively) compared with Pitt and SIRS scores (C-indices: 0.61 and 0.57, respectively; ROC values: 0.591 and 0.637, respectively). Cirrhotic patients with BSIs had high short-term mortality rates. Our data suggested that both CLIF-OF and MELD scores can be used to predict the short-term prognosis of these patients.