비대상성 간경변증 환자에서 병원감염발생의 위험요소
Risk factors for hospital acquired infections in patients with decompensated liver cirrhosis
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목적 : 세균성 감염은 진행성 간경변증환자에서 흔히 발생하는 합병증으로 타 질환에 비해 발생빈도가 높으며 종종 치명적이다. 본 연구에서는 입원한 비대상성 간경변증 환자에서 입원성 감염증의 위험인자를 알아보았다. 방법 : 108명의 비대상성 간경변증 환자를 대상으로 입원시부터 입원 후 72시간까지 임상적으로 감염이 없었던 117예와 입원 후 72시간 후에 감염증이 발생한 34예를 조사하였다. 질병의 원인, 간 및 신기능, 간경변증의 진행 및 합병증, 당뇨병, 상부위장관출혈, 간암동반, 침습성시술, 중환자실입원, 입원기간, 생존율 등과 감염발생과의 연관성을 알아보았다. 결과 : 혈청 알부민수치가 낮을수록 세균성 감염의 위험성이 증가하였으며 규명된 원인균 중 대부분이 장내세균이었으며 2/3 이상이 그람음성균이었다. 하지만 양군간 질병의 원인, 간 및 신기능, 간경변증의 진행 및 합병증, 당뇨병, 상부위장관출혈, 간암의 동반, 침습성시술, 중환자실입원, 입원기간, 생존율 등에서는 유의한 차이가 없었다. 결론 : 비대상성 간경변증 환자에서 저알부민혈증은 그람음성균에 의한 병원감염의 위험성을 증가시킨다.
Abstract
Background : Infection is a frequent complication in patients with chronic liver disease, mainly during the advanced stages. This study was performed to investigate the risk factors for infections in hospitalized patients with decompensated liver cirrhosis. Methods : We analyzed 108 decompensated hospitalized cirrhotic patients (34 cases with infection and 117 cases without infection) without clinical evidence of infection at the time of admission and during initial 72 hours after admission. Results : Univariate and multivariate analysis revealed that patients who developed an infection were more likely to have a lower serum albumin levels. Gram-negative bacterial strains were detected most frequently, in 13 of the 18 strains isolated. There was no significant difference in etiology of disease, Child-Pugh classification, cirrhotic complications including upper G-I bleeding, hepatocelluar caricnoma, invasive procedure, diabetus mellitus, admission to ICU, duration of admission, survival rate and various parameters related to liver and renal function between patients with infection and without infection. Conclusion : The present study indicates that decompensated cirrhotic patient with low serum albumin levels have a higher risk of developing a hospital acquired infection, especially by gram negative bacteria
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