Clinical impact of multidrug-resistant organisms in liver cirrhosis: A retrospective cohort study in the intensive care setting

Table 1 Baseline clinical and laboratory characteristics of intensive care unit patients with cirrhosis, stratified by multidrug-resistant organism colonization and decompensation phenotype (acute decompensation vs acute-on-chronic liver failure), n (%)/median (interquartile range)

Characteristics	Total (n = 107)	Without MDRO colonization (n = 75)	With MDRO colonization (n = 32)	P value1	AD (n = 20)	ACLF (n = 87)	P value1
Clinical and laboratory data
Age (years), median	60.0 (53.0, 67.0)	59 (53.0, 66.0)	61.0 (52.5, 69.0)	0.343	56.0 (50.3, 63.0)	61.0 (53.0, 68.0)	0.118
Gender				0.123			0.475
Male	74 (69.2)	48 (64.0)	26 (81.2)		12 (60.0)	62 (71.3)
Female	33 (30.8)	27 (36.0)	6 (18.8)		8 (40.0)	25 (28.7)
Hospital admission within last 3 months	40 (37.4)	25 (33.3)	15 (46.9)	0.268	7 (35.0)	33 (37.9)	1
ICU admission within last 3 months	12 (11.2)	7 (9.3)	5 (15.6)	0.542	4 (20.0)	8 (9.2)	0.231
Systemic antibiotics within last 3 months	38 (35.5)	23 (30.7)	15 (46.9)	0.167	5 (25.0)	33 (37.9)	0.406
Long-term norfloxacin prophylaxis	3 (2.8)	3 (4.0)	0 (0)	0.553	1 (5.0)	2 (2.3)	0.466
NSBB	41 (38.3)	27 (36.0)	14 (43.8)	0.591	9 (45.0)	32 (36.8)	0.67
IPP prior to hospital	58 (54.2)	39 (52.0)	19 (59.4)	0.659	12 (60.0)	46 (52.9)	0.774
IPP prior to ICU	76 (71.0)	50 (66.7)	26 (81.2)	0.197	15 (75.0)	61 (70.1)	0.872
TIPSS	8 (7.5)	5 (6.7)	3 (9.4)	0.694	1 (5.0)	7 (8.0)	1
WBC (× 109/L)	12.2 (7.8, 16.8)	12.4 (7.2, 17.8)	11.6 (9.2, 14.3)	0.498	9.8 (5.1, 12.1)	12.7 (8.3, 17.2)	0.034
Platelets (× 109/L)	88.0 (57.5, 122.0)	100.0 (64.0, 132.0)	76.5 (45.0, 100.0)	0.004	101.0 (76.3, 138.0)	84.0 (55.5, 118.5)	0.166
Serum creatinine (μmol/L)	150.0 (84.0, 278.5)	150.0 (88.0, 305.5)	140.5 (79.8, 220.0)	0.586	67.5 (59.5, 100.5)	185.0 (101.0, 317.0)	0.094
Serum sodium (mmol/L)	134.0 (130.0, 138.0)	134.0 (130.5, 138.0)	135.0 (129.0, 138.0)	0.751	136.5 (129.8, 142.8)	134.0 (130.0, 137.5)	0.246
Serum albumin (g/L)	26.0 (22.7, 29.5)	26.0 (22.4, 29.3)	26.0 (23.3, 30.0)	0.935	27.5 (22.0, 31.3)	26.0 (23.0, 29.0)	0.584
Serum bilirubin (μmol/L)	102.0 (45.0, 219.0)	100.0 (47.6, 207.0)	139.5 (42.5, 213.0)	0.586	69.5 (37.5, 94.3)	114.0 (49.0, 280.5)	0.094
INR	1.7 (1.4, 2.2)	1.6 (1.3, 2.2)	1.77 (1.6, 2.4)	0.156	1.4 (1.3, 1.5)	1.8 (1.5, 2.4)	0
CRP (mg/L)	36.1 (17.0, 73.5)	32.4 (15.4, 75.1)	36.6 (21.3, 68.9)	0.617	37.5 (13.0, 55.1)	35.0 (17.4, 80.5)	0.29
PCT (ng/mL)	1.1 (0.5, 2.8)	1.1 (0.5, 2.8)	1.2 (0.6, 2.2)	0.824	0.5 (0.1, 1.1)	1.3 (0.6, 2.9)	0.003
AST (U/L)	97.0 (49.0, 214.0)	110.0 (49.0, 262.0)	79.5 (50.0, 133.8)	0.187	76.0 (42.8, 130.8)	106.0 (52.0, 228.0)	0.303
ALT (U/L)	48.0 (21.0, 117.5)	60.0 (22.0, 141.0)	29.5 (18.3, 79.5)	0.039	39.5 (22.0, 101.5)	49.0 (20.50, 117.50)	0.851
GGT (U/L)	67.0 (34.0, 162.5)	80.0 (39.0, 225.0)	47.5 (24.0, 87.8)	0.011	141.5 (51.8, 564.5)	60.0 (30.5, 119.5)	0.01
ALP (U/L)	108.0 (87.0, 154.5)	109.0 (86.5, 179.5)	106.0 (90.8, 129.0)	0.492	100.0 (82.5, 187.3)	109.0 (87.0, 144.5)	0.876
Cirrhosis etiology
ALD	88 (82.2)	64 (85.3)	24 (75.0)	0.315	16 (80.0)	72 (82.8)	0.752
Chronic viral hepatitis	11 (10.3)	9 (12.0)	2 (6.2)	0.5	1 (5.0)	10 (11.5)	0.685
MASLD	6 (5.6)	3 (4.0)	3 (9.4)	0.361	2 (10.0)	4 (4.6)	0.312
PSC/PBC	1 (0.9)	1 (1.3)	0 (0)	1	1 (5.0)	0 (0)	0.187
AIH	1 (0.9)	1 (1.3)	0 (0)	1	1 (5.0)	0 (0)	0.187
Cryptogenic	8 (7.5)	5 (6.7)	3 (9.4)	0.694	0 (0)	8 (9.2)	0.347
HCC	3 (2.8)	1 (1.3)	2 (6.2)	0.212	1 (5.0)	2 (2.3)	0.466
Comorbidities
Diabetes mellitus	25 (23.4)	13 (17.3)	12 (37.5)	0.045	5 (25.0)	20 (23.0)	1
Cardiovascular diseases	50 (46.7)	33 (44.0)	17 (53.1)	0.513	7 (35.0)	43 (49.4)	0.359
Respiratory diseases	15 (14.0)	9 (12.0)	6 (18.8)	0.537	2 (10.0)	13 (14.9)	0.732
Chronic kidney diseases	13 (12.1)	8 (10.7)	5 (15.6)	0.692	2 (10.0)	11 (12.6)	1
Chronic hemodialysis	1 (0.9)	1 (1.3)	0 (0)	1	0 (0)	1 (1.1)	1
Disease severity at admission
MELD score	12.0 (10.0, 13.0)	11.0 (10.0, 13.0)	12.0 (10.8, 13.3)	0.365	10.0 (8.0, 11.0)	12.0 (10.5, 13.0)	0
MELD-Na score	27.4 (21.3, 33.5)	27.0 (21.4, 34.0)	29.08 (20.9, 32.6)	0.979	19.7 (16.0, 23.3)	29.3 (24.2, 35.2)	0
SOFA score	8.0 (6.0, 11.0)	8.0 (6.0, 10.0)	8.5 (7.0, 11.0)	0.247	5.5 (4.0, 7.0)	9.0 (7.0, 11.0)	0
CLIF ACLF score	61.0 (53.8, 66.0)	61.0 (56.0, 65.8)	58.0 (53.3, 65.8)	0.558	71.0 (71.0, 71.0)	61.0 (53.5, 65.5)	0.168
Type of ICU admission
Organ failure	48 (44.9)	36 (48.0)	12 (37.5)	0.431	9 (45.0)	39 (44.8)	1
Bleeding	11 (10.3)	9 (12.0)	2 (6.2)	0.5	5 (25.0)	6 (6.9)	0.046
Infection	35 (32.7)	18 (24.0)	17 (53.1)	0.007	2 (10.0)	33 (37.9)	0.017
Other	13 (12.1)	12 (16.0)	1 (3.1)	0.103	4 (20.0)	9 (10.3)	0.259
ACLF at ICU admission	87 (81.3)	57 (76.0)	30 (93.8)	0.033	0 (0.0)	87 (100.0)	0
Organ support at admission	63 (58.9)	44 (58.7)	19 (59.4)	1	7 (35.0)	56 (64.4)	0.031
Mechanical ventilation	45 (42.1)	30 (40.0)	15 (46.9)	0.656	7 (35.0)	38 (43.7)	0.647
Vasopressors	45 (42.1)	32 (42.7)	13 (40.6)	1	0 (0.0)	45 (51.7)	0
Outcomes
Mechanical ventilation	57 (53.3)	38 (50.7)	19 (59.4)	0.539	9 (45)	48 (55.2)	0.566
Acute RRT	36 (33.6)	23 (30.7)	13 (40.6)	0.438	1 (5)	35 (40.2)	0.003
Vasopressors	52 (48.6)	34 (45.3)	18 (56.2)	0.41	1 (5)	51 (58.6)	0
28-day transplant free survival	49 (45.8)	37 (49.3)	12 (37.5)	0.361	15 (75)	34 (39.1)	0.008
Overall ICU survival	55 (51.4)	41 (54.7)	14 (43.8)	0.41	17 (85)	38 (43.7)	0.001
Overall hospital survival	45 (42.1)	35 (46.7)	10 (31.2)	0.206	15 (75)	30 (34.5)	0.002
ICU LOS	8.0 (4.0, 16.0)	8.0 (4.0, 14.0)	10.0 (3.0, 18.3)	0.513	5.0 (3.0, 10.5)	9.0 (5.0, 17.0)	0.084
Hospital LOS	22.0 (12.0, 36.0)	21.0 (12.0, 31.0)	27.0 (17.8, 47.0)	0.083	20.5 (11.8, 37.0)	24.0 (12.0, 36.0)	0.946

¹P values were calculated using Fisher’s exact or Mann-Whitney U test, as appropriate.

ICU: Intensive care unit; NSBB: Non-selective beta-blockers; IPP: Infection prevention protocol; TIPSS: Transjugular intrahepatic portosystemic shunt; WBC: White blood cell count; INR: International normalized ratio; CRP: C-reactive protein; PCT: Procalcitonin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; ALD: Alcohol-associated liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cholangitis; AIH: Autoimmune hepatitis; HCC: Hepatocellular carcinoma; MELD: Model for End-Stage Liver Disease; SOFA: Sequential Organ Failure Assessment; CLIF: Chronic liver failure; ACLF: Acute-on-chronic liver failure; RRT: Renal replacement therapy; LOS: Length of stay; AD: Acute decompensation; MDRO: Multidrug-resistant organism.