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Bacterial infection increased cognitive impairment among cirrhotic patients

Patients with cirrhosis who developed bacterial infection were at significantly increased risk for cognitive impairment, according to recent results.

Researchers evaluated 150 patients with cirrhosis and 81 controls without liver disease. Incidence of bacterial infection, systemic inflammatory response syndrome (SIRS) and sepsis was observed. Psychometric and neurological assessments were performed upon initiation, in the event of and upon resolution of nosocomial infection, and 3 months after hospital discharge.

Fifty-four bacterial infections occurred among 50 patients with cirrhosis, including 31 cases of sepsis. Infection occurred in 33 controls; 23 cases resulted in sepsis. Cognitive impairment was observed in 42% of cirrhotic patients who did not develop infection (including 17% of cases with overt and 25% with subclinical impairment), compared with 79% who experienced infection without SIRS (42% overt, 37% subclinical) and 90% who experienced sepsis (29% overt and 61% subclinical). No controls experienced overt cognitive impairment, while nine controls with sepsis experienced subclinical impairment. During infection, overt (34% of patients vs. 0% of controls; P=.0002) and subclinical impairment (52% vs. 27%; P=.02) occurred more frequently among patients.

Overt hepatic encephalopathy (HE) was detected in 32 cirrhotic patients, 17 with infections. Minimal hepatic encephalopathy (MHE) was observed in 48 cirrhotic patients, and infection occurred in 26 cases. These patients performed significantly better on psychometric tests administered after infection resolution than those administered during infection.

Of 90 cirrhotic patients who underwent reevaluation 3 months after discharge — including 10 originally diagnosed with overt HE and 29 with MHE — none had overt HE and 28 had MHE.

Multivariate analysis indicated that infection was the only evaluated variable predictive of impairment among patients with cirrhosis (OR=9.5; 95% CI, 3.5-26.2).

“Cirrhotic patients with infection have a very high probability of developing HE,” the researchers concluded. “Subclinical HE may also be triggered by an infectious episode and can reverse after its resolution. The close correlation between … infection and the neurological symptoms highlights the importance of searching and treating infection in any cirrhotic patient with cognitive impairment.”