Mortality after urinary tract infections in patients with advanced cirrhosis - Relevance of acute kidney injury and comorbidities.

Background: Bacterial infections increase mortality four-fold in patients with decompensated cirrhosis. However, specific mortality associated with urinary tract infections (UTI) in cirrhosis is not known.

Methods: Retrospective single-centre analysis of all hospitalized patients with cirrhosis and ascites who underwent first paracentesis between 2006 and 2011 to determine 90-day mortality associated with UTI defined as pyuria with significant bacteriuria using Cox proportional hazard models.

Results: A total of 108 patients with at least one episode of UTI and 291 with exclusion of UTI were identified. Bacterial infections other than UTI were diagnosed in 136 (34%) of patients at the time of urine analysis. Female gender, Child-Pugh stage C, higher grade of ascites and systemic inflammatory response syndrome were associated with UTI. After adjustment for liver function and co-morbidity, the hazard ratios (HR) of death within 90 days after urine analysis were 2.08 (95% CI 1.28-3.38) in patients with UTI, 2.93 (1.90-4.52) in patients with other bacterial infections and 3.39 (2.03-5.65) in patients with UTI and concomitant infection. Independent predictors of death after UTI were renal dysfunction at presentation (HR 2.52; 95% CI 2.52), subsequent acute kidney injury within 48 h after diagnosis (4.57; 2.54-8.24), concomitant bacterial infection (1.77; 1.04-3.00) and malignant comorbidity (1.85; 1.03-3.30). The combination of these factors was more accurate in predicting 90-day mortality than the MELD score or C-reactive protein.

Conclusions: The presence of UTI indicates an increased risk of 90-day mortality in patients with advanced cirrhosis. Renal dysfunction and comorbidities are predictors of death in these patients.