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Article

A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy

  • Authors:
    • Qiu-Ming Wang
    • Qing Ji
    • Zhi-Jun Duan
    • Ming Zhang
    • Qing-Yong Chang
  • View Affiliations / Copyright

    Affiliations: Department of Gastroenterology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China, Department of Gastroenterology, Shiyan Taihe Hospital, Shiyan, Hubei 44200, P.R. China, The Second Affiliated Hospital of Xi'an Medical College, Xi'an, Shaanxi 710038, P.R. China, Department of Neurosurgery, Zhongshan Affiliated Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
  • Pages: 584-590
    |
    Published online on: June 3, 2013
       https://doi.org/10.3892/etm.2013.1137
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Abstract

Hepatic encephalopathy (HE) is a severe and high‑mortality complication in cirrhotic patients. In this study, we analyzed infection, one of the common precipitating factors of HE in patients with cirrhosis, in order to identify common infection sites and the etiology. In addition, we aimed to identify information useful in the early prevention and effective treatment of HE. Ninety-two patients presenting with hepatitis B virus-related cirrhosis with HE (HBC-HE) and 45 patients presenting with alcoholic cirrhosis with HE (ALD‑HE) were enrolled in this study. We collected and analyzed data concerning the precipitating factors of HE using blood tests, biochemical detection and bacterial culture to identify which precipitating factor was the most common. Fifty-three patients with HE (37 with HBC-HE and 16 with HBC-HE) had infection as the precipitating factor. These infections included respiratory tract infection (56.6%), intestinal tract infection (20.7%), peritoneal infection (17.0%) and urinary tract infection (5.7%). The white blood cell (WBC) counts increased in 17 cases (32.1%) and neutrophil (NEUT) numbers increased in 39 cases (73.6%), while WBC counts were lower in the patients with respiratory tract infection compared with those in the patients with infections at other sites (P<0.05). The levels of plasma ammonia were significantly higher in patients with intestinal tract infection than in those with other sites of infection (P<0.05). The proportions of patients with hyperammonemia, increased NEUT numbers, hyponatremia and low albumin were higher in the infection group compared with those in the non-infection group (P<0.05). Pneumococci and E. coli were common bacteria that induced infection in the respiratory tract and at other infection sites, respectively. Respiratory tract infection was identified to be the most common precipitating factor for HE.
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1. 

Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K and Blei AT: Hepatic encephalopathy - definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 35:716–721. 2002. View Article : Google Scholar

2. 

Zhang FK, Zhang JY and Jia JD: Treatment of patients with alcoholic liver disease. Hepatobiliary Pancreat Dis Int. 4:12–17. 2005.PubMed/NCBI

3. 

Häussinger D: Hepatic encephalopathy. Acta Gastroenterol Belg. 73:457–464. 2010.

4. 

Shawcross DL, Sharifi Y, Canavan JB, et al: Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis. J Hepatol. 54:640–649. 2011. View Article : Google Scholar : PubMed/NCBI

5. 

Bustamante J, Rimola A, Ventura PJ, et al: Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 30:890–895. 1999. View Article : Google Scholar : PubMed/NCBI

6. 

Bellot P, Jara Pérez López N, Martínez Moreno B and Such J: Current problems in the prevention and treatment of infections in patients with cirrhosis. Gastroenterol Hepatol. 33:729–740. 2010.(In Spanish).

7. 

Zhuang J: 52 cases analysis of precipitating factors in cirrhosis with hepatic encephalopathy. J Clin Hepatol. 10:57–58. 2007.(In Chinese).

8. 

Zhang M and Duan ZJ: Retrospective analysis of factors influencing the development and progression of hepatic encephalopathy in patients with hepatitis B virus related cirrhosis. Shi Jie Hua Ren Xiao Hua Za Zhi. 20:1148–1155. 2012.(In Chinese).

9. 

O’Shea RS, Dasarathy S, McCullough AJ, et al Practice Guideline Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology: Alcoholic liver disease. Hepatology. 51:307–328. 2010.

10. 

Papadopoulos N, Soultati A, Goritsas C, et al: Nitric oxide, ammonia, and CRP levels in cirrhotic patients with hepatic encephalopathy: is there a connection? J Clin Gastroenterol. 44:713–719. 2010. View Article : Google Scholar : PubMed/NCBI

11. 

Devrajani BR, Shah SZ, Devrajani T and Kumar D: Precipitating factors of hepatic encephalopathy at a tertiary care hospital Jamshoro, Hyderabad. J Pak Med Assoc. 59:683–686. 2009.PubMed/NCBI

12. 

McAvoy HC and Hayes PC: Hepatic encephalopathy. Medicine. 35:108–111. 2006. View Article : Google Scholar

13. 

Häussinger D and Görg B: Interaction of oxidative stress, astrocyte swelling and cerebral ammonia toxicity. Curr Opin Clin Nutr Metab Care. 13:87–92. 2010.PubMed/NCBI

14. 

Atluri DK, Prakash R and Mullen KD: Pathogenesis, diagnosis, and treatment of hepatic encephalopathy. J Clin Exp Hepatol. 1:77–86. 2011. View Article : Google Scholar

15. 

Vaquero J, Polson J, Chung C, et al: Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology. 125:755–764. 2003. View Article : Google Scholar : PubMed/NCBI

16. 

Licinio J and Wong ML: Pathways and mechanisms for cytokine signaling of the central nervous system. J Clin Invest. 100:2941–2947. 1997. View Article : Google Scholar : PubMed/NCBI

17. 

Bémeur C, Desjardins P and Butterworth RF: Antioxidant and anti-inflammatory effects of mild hypothermia in the attenuation of liver injury due to azoxymethane toxicity in the mouse. Metab Brain Dis. 25:23–29. 2010.PubMed/NCBI

18. 

Cauli O, Rodrigo R, Piedrafita B, Llansola M, Mansouri MT and Felipo V: Neuroinflammation contributes to hypokinesia in rats with hepatic encephalopathy: ibuprofen restores its motor activity. J Neurosci Res. 87:1369–1374. 2009. View Article : Google Scholar : PubMed/NCBI

19. 

Rodrigo R, Cauli O, Gomez-Pinedo U, et al: Hyperammonemia induces neuroinflammation that contributes to cognitive impairment in rats with hepatic encephalopathy. Gastroenterology. 139:675–684. 2010. View Article : Google Scholar : PubMed/NCBI

20. 

Karvellas CJ, Pink F, McPhail M, et al: Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute-on-chronic liver failure. Crit Care Med. 38:121–126. 2010.

21. 

Shawcross DL, Olde Damink SW, Butterworth RF and Jalan R: Ammonia and hepatic encephalopathy: the more things change, the more they remain the same. Metab Brain Dis. 20:169–179. 2005. View Article : Google Scholar : PubMed/NCBI

22. 

Cauli O, Rodrigo R, Piedrafita B, Boix J and Felipo V: Inflammation and hepatic encephalopathy: ibuprofen restores learning ability in rats with portacaval shunts. Hepatology. 46:514–519. 2007. View Article : Google Scholar : PubMed/NCBI

23. 

Shawcross DL, Davies NA, Williams R and Jalan R: Systemic inflammatory response exacerbates the neuropsychological effects of induced hyperammonemia in cirrhosis. J Hepatol. 40:247–254. 2004. View Article : Google Scholar : PubMed/NCBI

24. 

Blei AT: Infection, inflammation and hepatic encephalopathy, synergism redefined. J Hepatol. 40:327–330. 2004. View Article : Google Scholar : PubMed/NCBI

25. 

Shawcross DL, Wright G, Olde Damink SW and Jalan R: Role of ammonia and inflammation in minimal hepatic encephalopathy. Metab Brain Dis. 22:125–138. 2007. View Article : Google Scholar : PubMed/NCBI

26. 

Sharifi Y, Canavan JB, Yeoman AD, et al: Defining the outcome, precipitants and cost of severe hepatic encephalopathy (HE) in cirrhosis. Hepatology. 48(Suppl): 1061A2008.

27. 

Shawcross DL, Shabbir SS, Taylor NJ and Hughes RD: Ammonia and the neutrophil in the pathogenesis of hepatic encephalopathy in cirrhosis. Hepatology. 51:1062–1069. 2010. View Article : Google Scholar : PubMed/NCBI

28. 

Shawcross DL, Wright GA, Stadlbauer V, et al: Ammonia impairs neutrophil phagocytic function in liver disease. Hepatology. 48:1202–1212. 2008. View Article : Google Scholar : PubMed/NCBI

29. 

Wasmuth HE, Kunz D, Yagmur E, et al: Patients with acute-on-chronic liver failure display ‘sepsis-like’ immune paralysis. J Hepatol. 42:195–201. 2005.

30. 

Antoniades CG, Wendon J and Vergani D: Paralysed monocytes in acute-on-chronic liver disease. J Hepatol. 42:163–165. 2005. View Article : Google Scholar : PubMed/NCBI

31. 

Lin CY, Tsai IF, Ho YP, et al: Endotoxemia contributes to the immune paralysis in patients with cirrhosis. J Hepatol. 46:816–826. 2007. View Article : Google Scholar : PubMed/NCBI

32. 

Rosa H, Silvério AO, Perini RF and Arruda CB: Bacterial infection in cirrhotic patients and its relationship with alcohol. Am J Gastroenterol. 95:1290–1293. 2000. View Article : Google Scholar : PubMed/NCBI

33. 

Borzio M, Salerno F, Piantoni L, et al: Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 33:41–48. 2001. View Article : Google Scholar : PubMed/NCBI

34. 

Wiest R and Rath HC: Gastrointestinal disorders of the critically ill. Bacterial translocation in the gut. Best Pract Res Clin Gastroenterol. 17:397–425. 2003. View Article : Google Scholar : PubMed/NCBI

35. 

Andreu M, Sola R, Sitges-Serra A, et al: Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterology. 104:1133–1138. 1993.PubMed/NCBI

36. 

Bernardi M: Spontaneous bacterial peritonitis: from pathophysiology to prevention. Intern Emerg Med. 5(Suppl 1): S37–S44. 2010. View Article : Google Scholar : PubMed/NCBI

37. 

Sigal SH: Hyponatremia in cirrhosis. J Hosp Med. 7(Suppl 4): S14–S17. 2012. View Article : Google Scholar

38. 

Angeli P, Wong F, Watson H and Ginès P; CAPPS Investigators: Hyponatremia in cirrhosis: Results of a patient population survey. Hepatology. 44:1535–1542. 2006. View Article : Google Scholar : PubMed/NCBI

39. 

Häussinger D and Schliess F: Pathogenetic mechanisms of hepatic encephalopathy. Gut. 57:1156–1165. 2008.

40. 

Amodio P, Del Piccolo F, Pettenò E, et al: Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 35:37–45. 2001. View Article : Google Scholar : PubMed/NCBI

41. 

Baccaro ME, Guevara M, Torre A, Arcos E, Martin-Llahí M, Terra C, Gómez-Anson B, Rami L, Arroyo V and Ginès P: Hyponatremia predisposes to hepatic encephalopathy in patients with cirrhosis. Results of a prospective study with time-dependent analysis. Hepatology. 44(Suppl 1): 233A2006.

42. 

Fernández J, Navasa M, Gómez J, et al: Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 35:140–148. 2002.PubMed/NCBI

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Copy and paste a formatted citation
Spandidos Publications style
Wang Q, Ji Q, Duan Z, Zhang M and Chang Q: A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy. Exp Ther Med 6: 584-590, 2013.
APA
Wang, Q., Ji, Q., Duan, Z., Zhang, M., & Chang, Q. (2013). A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy. Experimental and Therapeutic Medicine, 6, 584-590. https://doi.org/10.3892/etm.2013.1137
MLA
Wang, Q., Ji, Q., Duan, Z., Zhang, M., Chang, Q."A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy". Experimental and Therapeutic Medicine 6.2 (2013): 584-590.
Chicago
Wang, Q., Ji, Q., Duan, Z., Zhang, M., Chang, Q."A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy". Experimental and Therapeutic Medicine 6, no. 2 (2013): 584-590. https://doi.org/10.3892/etm.2013.1137
Copy and paste a formatted citation
x
Spandidos Publications style
Wang Q, Ji Q, Duan Z, Zhang M and Chang Q: A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy. Exp Ther Med 6: 584-590, 2013.
APA
Wang, Q., Ji, Q., Duan, Z., Zhang, M., & Chang, Q. (2013). A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy. Experimental and Therapeutic Medicine, 6, 584-590. https://doi.org/10.3892/etm.2013.1137
MLA
Wang, Q., Ji, Q., Duan, Z., Zhang, M., Chang, Q."A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy". Experimental and Therapeutic Medicine 6.2 (2013): 584-590.
Chicago
Wang, Q., Ji, Q., Duan, Z., Zhang, M., Chang, Q."A study on the position and etiology of infection in cirrhotic patients: A potential precipitating factor contributing to hepatic encephalopathy". Experimental and Therapeutic Medicine 6, no. 2 (2013): 584-590. https://doi.org/10.3892/etm.2013.1137
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