الفهرس 
Introduction and aim of the work
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Our study aimed to evaluate the prevalence of bacterial infection in patients with acute-on-chronic liver failure (ACLF). Our study population was patients who were admitted to the ICU at Hopital Beaujon, Paris, France, with ACLF (according to the EASL- CLIF consortium definition) and circulatory failure, defined as the need for norepinephrine to achieve a -target mean arterial pressure of 65mmHg after adequate fluid resuscitation. Patients with hypovolemic shock, cardiogenic shock, anaphylactic shock, and cirrhotic patients with HIV co-infection were excluded from our study.
Baseline patient data included gender, age, date of admission, age at admission, beta blockers and antibiotic use before admission were collected. In addition, the baseline values of bilirubin, creatinine, INR, and lactic acid levels were recorded; the respective values were followed up at day 1, 2, 3, 7, and 14, or until death of the patient or liver transplantation. The use of mechanical ventilation, renal replacement therapy or both at any time from admission till discharge from the ICU was usually associated with increased mortality. Multiple cultures were performed for all patients to detect any infection. Performed cultures included blood, sputum, stool, urine, skin, and ascetic fluid. The results of these cultures were collected.
This study included 83 patients, 62 of them (74.7%) were males. Bacterial infection was proved by positive cultures in 80.7% of our study population. More than 50% of 444 performed culture were positive. Escherichia coli was the most frequent organism found in performed cultures (14.2%). Spontaneous bacterial peritonitis (28.9%) was the most common type of infection in our study population, followed by urinary tract infection (24.1%), then chest infection (21.7%).
We did not find any significant difference between patients with and without bacterial infection either in data collected before admission or after follow-up. There was also no notable difference in the survival rates between infected and non-infected patients. The presence of multiple infections in different sites did not affect mortality rates. Liver transplantation was done for 12.05% of our study population. Six-month survival rate in those patients was 80%, while 1-year survival rate was 50%.
At admission, we found that lower levels of bilirubin and history of non-selective beta-blockers were associated with better survival rates. Follow up data of our patients during their presence in the ICU, we found that mortality rate is significantly higher in patients who required mechanical ventilation and renal replacement therapy. Survived patients had significantly lower levels of lactic acid, and PH. We also observed that patients with significant prolongation in the prothrombin time had higher mortality rate.