SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gut
  2015/11  
 
  2015 Oct 28. pii: gutjnl-2015-310275  
  doi: 10.1136/gutjnl-2015-310275  
 
  Bacterial infection in compensated viral cirrhosis impairs 5-year survival (ANRS CO12 CirVir prospective cohort)  
 
  Nahon P, Lescat M, Layese R, Bourcier V, Talmat N, Allam S, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Trinchet JC, Moreau R, Roudot-Thoraval F; ANRS CO CirVir and Microcir Groups.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Bacterial+infection+in+compensated+viral+cirrhosis+impairs+5-year+survival+%28ANRS+CO12+CirVir+prospective+cohort%29.  
 
 

OBJECTIVE:

To assess incidence and prognostic significance of bacterial infections (BIs) occurring in compensated viral cirrhosis.

DESIGN:

This prospective study involved 35 French centres. Inclusion criteria were biopsy-proven HCV or HBV cirrhosis, Child-Pugh A and no previous hepatic complications. Cumulative incidence (CumI) of events was estimated in a competing risks framework.

RESULTS:

1672 patients were enrolled (HCV 1323, HBV 318, HCV-HBV 31). During a median follow-up of 43 months, 234 BIs occurred in 171 patients (5 year CumI: 12.9%), among whom 14.6% had septic shock. Main localisations included the urinary tract (27.4%), lung (25.2%) and peritoneum (10.7%) (other, 86 (36.7%)). Most BIs occurred as a first event prior to liver decompensation (n=140, 81.8%) and were community-acquired (CA, 84.2%). The risk of BI was higher in patients with HCV than in patients with HBV (5 year CumI: 15.2% vs 5.5%, p=0.0008). Digestive localisation, concomitant interferon-based treatment, isolation of resistant bacteria and non-CA BIs were associated with lowest probability of resolution. The occurrence of a first BI impaired survival in patients infected with HCV (5 year survival: 60.2% vs 90.4%, p<0.001) and patients infected with HBV (5 year survival: 69.2% vs 97.6%, p<0.001). BIs represented the third cause of death (14.1%) after liver failure and liver cancer. BI risk factors comprised older age, lower albumin, proton pump inhibitor intake and absence of virological eradication/control.

CONCLUSION:

BI mostly occurs as a first complication and represents a turning point in the course of compensated viral cirrhosis. Its occurrence impacts long-term prognosis and may define a subgroup of patients in whom adaptation of management is warranted.

 
Question posée
 
Quelles sont l’incidence et la valeur pronostique des infections bactériennes survenant chez les patients ayant une cirrhose virale compensée ?
 
Question posée
 
Les infections bactériennes sont un tournant pronostic majeur dans l’histoire naturelle de la cirrhose virale avec une diminution très significative de la survie à 5 ans. C’est la 3ième cause de mort derrière l’insuffisance hépatocellulaire et le cancer du foie. Les facteurs associés sont l’âge avancé, l’hypoalbuminémie, le traitement par IPP et l’absence d’éradication ou de contrôle de l’infection virale.
 
Commentaires

Etude majeure dans la prise en charge des cirrhoses virale, soulignant l’importance du traitement anti-viral et de l’indication de la transplantation hépatique afin d’améliorer le pronostic.

 
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