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Arai M, Kanda T, Yasui S, et al. Opportunistic infection in patients with acute liver failure. Hepatol Int. 2014;8(2):233-9doi: 10.1007/s12072-013-9514-4.
Arai, M., Kanda, T., Yasui, S., Fujiwara, K., Imazeki, F., Watanabe, A., Sato, T., Oda, S., & Yokosuka, O. (2014). Opportunistic infection in patients with acute liver failure. Hepatology international, 8(2), 233-9. https://doi.org/10.1007/s12072-013-9514-4
Arai, Makoto, et al. "Opportunistic infection in patients with acute liver failure." Hepatology international vol. 8,2 (2014): 233-9. doi: https://doi.org/10.1007/s12072-013-9514-4
Arai M, Kanda T, Yasui S, Fujiwara K, Imazeki F, Watanabe A, Sato T, Oda S, Yokosuka O. Opportunistic infection in patients with acute liver failure. Hepatol Int. 2014 Apr;8(2):233-9. doi: 10.1007/s12072-013-9514-4. Epub 2014 Jan 24. PMID: 26202504.
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Hepatol Int. 2014 Apr;8(2):233-9. doi: 10.1007/s12072-013-9514-4. Epub 2014 Jan 24.

Opportunistic infection in patients with acute liver failure.

Hepatology international

Makoto Arai, Tatsuo Kanda, Shin Yasui, Keiichi Fujiwara, Fumio Imazeki, Akira Watanabe, Takeyuki Sato, Shigeto Oda, Osamu Yokosuka

Affiliations

  1. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. [email protected].
  2. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan.
  3. Division of Control and Treatment of Infectious Disease, Chiba University, Chiba, Japan.
  4. Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.

PMID: 26202504 DOI: 10.1007/s12072-013-9514-4

Abstract

BACKGROUND: Treatment with systemic corticosteroids is often used for acute liver failure (ALF), but this has increased the number of profoundly immunocompromised patients and cases of opportunistic infection.

METHODS: Between January 2007 and December 2012, all patients (n = 51) referred to the Chiba University Hospital for treatment of ALF were studied. Patients with prothrombin activity of 40 % or less of the standardized values were defined as having ALF. Patient age, sex, cause of ALF, alanine aminotransferase and total bilirubin levels, prothrombin activity and total amount of corticosteroid were analyzed to determine the factors associated with the occurrence of opportunistic infection.

RESULTS: Opportunistic infections occurred in 21.6 % (n = 11) of ALF patients. Thirty-five patients underwent systemic corticosteroid therapy, and 31.4 % of those patients showed opportunistic infections. Cytomegalovirus (n = 9, 81.8 %) and Pneumocystis jiroveci (n = 6, 54.5 %) were the microorganisms frequently suspected as the causes of opportunistic infection. In 7 (63.6 %) of the 11 cases of opportunistic infection, 2 or more species of microorganism were detected. Seven patients (63.6 %) with opportunistic infection were cured by treatment. Cox regression analysis for the patients who underwent systemic corticosteroid therapy steroid treatment revealed that age over 52 years (compared to younger patients: odds ratio = 9.62, 95 % confidence interval = 1.22-76.9) was only the predictive factor for the occurrence of opportunistic infection.

CONCLUSION: Opportunistic infections are not rare in ALF patients, and the appropriate diagnosis and treatment of these infections are critical during ALF treatment.

Keywords: Acute liver failure; Cytomegalovirus; Opportunistic infection; Pneumocystis jiroveci; Steroid

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