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Díaz L1, Idalsoaga F1, Ayares G1, Arnold J1, Alcayaga B1, Maldonado K2, Ayala M3, Perez D3, Gomez J3, Escarate R3, Fuentes E1, Roblero J4, Simian D4, Norero B5, Lazarte R6, Velarde J7, Higuera-de-la-Tijera F8, Córdova J9, Varela J10, Mejía S11, Silva R12, Melo C13, Araujo R14, Pereira G15, Couto C16, Bessone F17, Tanno M17, Romero G18, Mendizabal M19, Marciano S20, Gomez G20, Dirchwolf M21, Montes P22, Guerra P23, Ramos G23, Restrepo J24, Carrera E25, Brahmania M26, Singal A27, Bataller R28, Shah V29, Kamath P29, Arrese M1, Arab J30
1Pontificia Universidad Católica de Chile, Santiago, Chile
2Roosevelt Hospital, Ciudad de Guatemala, Guatemala
3Hospital El Pino, Santiago, Chile
4Sección Gastroenterología, Santiago, Chile
5Hospital Dr. Sótero del Río, Santiago, Chile
6Clínica Hospital del Profesor, Santiago, Chile
7Hospital Civil Guadalajara, Guadalajara, México
8Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, México
9Hospital General Manuel Gea González, Mexico City, México
10Hospital Dublán, Chihuahua, México
11Hospital Juárez de México, Mexico City, México
12Hospital de Base da Faculdade de Medicina de São Jose do Rio Preto, Sao Paulo, Brasil
13Fhaj Fundação Hospital Adriano Jorge, Amazonas, Brasil
14Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil
15Hospital Federal de Bonsucesso, Rio de Janeiro, Brasil
16Hospital das Clinicas Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
17Hospital Provincial del Centenario, Santa Fe, Argentina
18Hospital de Gastroenterología ” Dr. Carlos Bonorino Udaondo”, Buenos Aires, Argentina
19Hospital Universitario Austral, Buenos Aires, Argentina
20Hospital Italiano Buenos Aires, Buenos Aires, Argentina
21Hospital Privado de Rosario, Rosario, Argentina
22Hospital Nacional Daniel Alcides Carrión – Callao, Bellavista, Perú
23Instituto Gastroenterológico Boliviano- Japonés, Cochabamba, Bolivia
24Universidad de Antioquia, Medellin, Colombia
25Hospital Especialidades Eugenio Espejo, Quito, Ecuador
26Univeristy of Calgary, Calgary, Canadá
27University of South Dakota Sanford School of Medicine, Sioux Falls, Estados Unidos (EEUU)
28Hospital Clinic, Barcelona, España
29Mayo Clinic, Rochester, Estados Unidos (EEUU)
30Western University, London Health Sciences Center, London, Canadá
Background: Patients with severe alcohol-associated hepatitis (AH) are at higher infection risk.
Aims: To assess the impact of infections in patients with AH in a multinational cohort in Latin America.
Methods: Multicenter prospective cohort study including patients with AH between 2015–2022. We recorded clinical data, including infections and antibiotic use. We assessed the impact of infections using competing-risk models.
Results: We included 511 patients from 24 centers in 8 countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru). The mean age was 50.1±11.9 years, 426 (83.9%) were men, 264 (58.2%) had a previous diagnosis of cirrhosis, and the median MELD at diagnosis was 24.6 [19.6–30.6] points. Out of the total, 25.9% died, and only 3.7% underwent liver transplantation during follow-up. Around 44.5% of patients developed an infection. Of them, 50.9% presented with infection at admission, 30.8% developed an infection during hospitalization, and 18.3% presented an infection in both situations. The most common localizations at admission were pulmonary (32.4%), urinary tract (33.1%), spontaneous bacterial peritonitis (15.9%), and cutaneous (9.7%). The main localizations during hospitalization were pulmonary (34.4%), urinary tract (25.8%), spontaneous bacterial peritonitis (14.0%), and bacteremia (8.6%%). The incidence of multidrug-resistant (MDR) organisms was 11.2% at admission and 10.3% during hospitalization, while the incidence of extensively drug-resistant (XDR) organisms was 1.4% and 4.7%, respectively. The presence of infection was associated with higher mortality (sub-distribution hazard ratio [sHR] 1.92, 95%CI:1.56–2.37; p<0.001)(Figure). The infections were independently associated with mortality (sHR 1.33, 95%CI:1.02–1.75; p=0.037) in a competing-risk model adjusted by age, sex, MELD, and ACLF.
Conclusions: Infections during an AH episode are frequent and independently associated with mortality inLatin America. However, the incidence of MDR and XDR organisms was lower than in other regions.
