利福昔明对肝硬化失代偿期和肝性脑病患者感染和死亡率的影响。

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
ACS Applied Electronic Materials Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI:10.1177/17562848241254267
Francisco Idalsoaga, Camila Robles, Andrea Ortiz, Oscar Corsi, Eduardo Fuentes-López, Luis Antonio Díaz, Gustavo Ayares, Marco Arrese, Juan Pablo Arab
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引用次数: 0

摘要

导言:肝硬化患者的感染与高发病率和高死亡率有关。目的:评估利福昔明在预防肝硬化相关感染(自发性细菌性腹膜炎、肺炎、尿路感染(UTI)和菌血症)、艰难梭菌感染和全因死亡率方面的作用,并确定不良反应和用药依从性:2017年1月至2022年11月期间,某大学中心对有肝硬化病史的失代偿期肝硬化患者进行了一项回顾性队列研究。无论病因和严重程度如何,肝硬化患者均被纳入研究,包括住院和门诊病例。统计分析包括调整后的一般线性模型、泊松回归和倾向得分匹配:我们共纳入了 153 名患者。平均年龄为 60.2 ± 12.3 岁,女性 67 人(占 43.8%)。肝硬化的主要病因是代谢功能障碍相关性脂肪性肝病 52 例(38%),终末期肝病钠模型中位数为 16.5(7-32)。队列中有 65 名(45%)患者使用利福昔明。平均随访时间为 32 个月。85名患者发生了感染事件,共登记了164起感染事件。主要感染事件为尿毒症(62 例,占 37.8%)和肺炎(38 例,占 23.2%)。利福昔明的使用与较低的感染率有关,其发病率比(IRR)为 0.64 [95% 置信区间 (CI) (0.47-0.89); p = 0.008]。但对死亡率结果没有明显影响[IRR 1.9,95% 置信区间 (0.9-4.0);p = 0.09]。没有不良反应的报告,也没有患者因不良反应而中断治疗:结论:利福昔明能显著减少肝硬化合并肝癌患者的感染。尽管利福昔明与全因死亡率的降低有关,但在调整分析中这一影响并无统计学意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of rifaximin use in infections and mortality in patients with decompensated cirrhosis and hepatic encephalopathy.

Introduction: Infections in patients with cirrhosis are associated with high morbidity and mortality. Rifaximin is an antibiotic used to treat and prevent hepatic encephalopathy (HE); however, it has been suggested that it may play a crucial role in reducing infections in these populations.

Aim: To evaluate the role of rifaximin in preventing frequent cirrhosis-related infections [spontaneous bacterial peritonitis, pneumonia, urinary tract infection (UTI), and bacteremia], Clostridioides difficile infection, and all-cause mortality, as well as determining adverse effects and adherence to the drug.

Methods: A retrospective cohort study was conducted on decompensated cirrhotic patients with history of HE between January 2017 and November 2022 at a university center. Patients with cirrhosis, regardless of their etiology and severity, were included in the study, encompassing both hospitalized and outpatient cases. The statistical analysis included adjusted general linear models, Poisson regressions, and propensity score matching.

Results: We included 153 patients. The mean age in the cohort was 60.2 ± 12.3 years and 67 (43.8%) were women. The main cause of cirrhosis was metabolic dysfunction-associated steatotic liver disease 52 (38%), and the median Model of End-Stage Liver Disease sodium was 16.5 (7-32). In the cohort, 65 (45%) patients used rifaximin. The mean follow-up was 32 months. Eighty-five patients with infectious events were recorded, and a total of 164 infectious events were registered. The main infectious events were UTIs (62, 37.8%) and pneumonia (38, 23.2%). The use of rifaximin was associated with lower infection rates, displaying an incidence rate ratio (IRR) of 0.64 [95% confidence interval (CI) (0.47-0.89); p = 0.008]. However, no discernible impact on mortality outcome was observed [IRR 1.9, 95% CI (0.9-4.0); p = 0.09]. There were no reported adverse effects, and no patient discontinued the therapy due to adverse effects.

Conclusion: The use of rifaximin significantly reduces infections in patients with cirrhosis and HE. Despite rifaximin was associated with a decreased all-cause mortality, this impact was not statistically significant in the adjusted analysis.

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