The Effect of Splenectomy on the Risk of Infection in Patients With Liver Cirrhosis

Abstract Background: Splenectomy has been reported to improve liver function as well as hypersplenism, but it is still controversial whether splenectomy will further damage the immune function of patients with liver cirrhosis. This study aims to evaluate the impact of splenectomy on the risk of infection in patients with liver cirrhosis. Methods: A total of 4355 patients with liver cirrhosis admitted to the First Affiliated Hospital of Nanjing Medical University from October 1, 2016 to September 30, 2020 were enrolled. The patients were first divided into the splenectomy group (SG) and the non-splenectomy group (NSG). After standardization, patients were further divided according to the stage of cirrhosis. Infection rates in different stages were calculated, respectively. Laboratory results and infection sites of patients with cirrhosis were analyzed in combination with clinical data. Continuous variables conforming to normal distribution were presented as mean ± standard deviation, compared by sample t test or paired sample t test. Non-normal variables were presented as the median (interquartile range) and compared by Mann-Whitney U test or Wilcoxon signed rank test. Results: Five hundred and two patients received splenectomy and 3853 patients did not. Bacterial infection was diagnosed in 497 of the 4355 (11.41%) hospitalizations of patients with cirrhosis. The infection rate of the compensated cirrhosis SG was higher than that of the NSG (8.06% vs. 5.18%, P < 0.05). However, the infection rate in the SG with decompensated cirrhosis was lower than that in the NSG (11.35% vs. 22.22%, P < 0.001). The peak level of leukocytes did not differ significantly between the SG with compensated liver cirrhosis and the NSG [11.97 (7.65) × 109/L vs. 12.19 (14.04) × 109/L, P > 0. 05]. The peak value of leukocytes in SG suffering from decompensated liver cirrhosis was significantly higher than that in NSG [12.29 (11.52) × 109/L vs. 6.37 (8.90) × 109/L, P = 0.004]. Patients with decompensated liver cirrhosis had a significantly higher rate of abdominal infection than patients with compensated liver cirrhosis, and splenectomy itself did not affect the sites of infection. Conclusions: Splenectomy increases the risk of infection for patients with compensated liver cirrhosis, but significantly decreases the risk in patients with decompensated liver cirrhosis.