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1 » :616.9(043.3) :
2 «-» :,,, :,,, - «-», -,,, - - «- -» : «- -» : ,.,, 83, uchsovet@bsmu.by, ,,..
3 1 ( ) -. -, ( ), - ( ).,, -. [Foreman M. G. et al., 2003; Arvanti V. et al., 2010].. [Wong F. et al., 2005]. -. -,. -,. ( ), , , , (,, - ). «- C282Y H63D», ( ). : -,.
4 2 1., CLIF-C : 151, 378. : -, -,.. -, -,. -,. - - ( )., ( ). CLIF-C. -, - ( ) - ( ),, -. ( ) [36]. - ( )., 1. 44,4% - ( -
5 3,, ), 41,9% (,, ), 34,3% (, ). - -, 56% ,, ,3%,,, 49,3%, 37,1%. 56,8%. - 5,3, 6, : 7-9,7 (p<0,001) -, CLIF-C Child-Pugh ( 0,97 0,66, =0,015) , URIstik A10 > 2, 10 > 1; > ,, -. -, -,. -
6 4,, - ( ( ), ). -, -,, -,, 85%. -.., -, «-», ( -, 2010, 2011, 2013, 2014), IV «-» (, 2012), II «2011» (, 2011), II «.» ( -, 2012), «-» (, 2012),, - (, 2011, 2012), - «, -» (, 2011),» (, 2014), - (, 2013, 2014,, 2015), EASL «-» (,, 2015), EASL - «:» (,, 2015), Falk 199 «- 2015: -» (,, 2015), Falk 201 :» (,, 2016), (,, 2016). 9, 2. - :»., «2-»., «3-
7 5...».,, «3»,, «1»,, «- -» ,, (9,9 ),,, 15 (1,6 ) , 1.., -,, 5,, , 76 (22 ) 17 (7 ), (14 ). «-» :, 210 ( ),, 36. ( - ).,, 151, 3» ( 55 [43 ; 61 ]), , 18. -, ,
8 6 «-» (308, , 18 80, 53 [45 ; 59 ]) - ( , 39 31, 27 80, 53, [42 ; 58 ]). -., (33 24 ) ( - 55 [43 ; 61 ]) - «3». ( ) ( ). - (, ), (,,, ). - MEK-7222 (NIHON KOHDEN, - ). Cormay ( ), ( ), «+» ( ), ( ), ( - ) SOLAR PM 2111 ( - ). Plus (Medica, ) Easy-Life (Medica, ), 4- SOLAR ( )..,,,. - ( ) - HiMedia (HiMedia Laboratories Pvt. Limited, ),
9 7 MiniApi (BioMerieux, ) ), -,. - GIF-XQ30 (Olimpus, ). SA 8000 (Medison, ) -. Child-Puhg [Pugh R. N. et al., 1973], - [Moor K. P. et al., 2003]. - (,,,, - ) [Fasolato S. et al., 2007], - [Bone R. C. et al., 1992]. («acuteon-chronic» liver failure, ACLF), - R. Moreau et al. (2013) CLIF- (Chronic Liver Failure-Consortium), SOFA (Sequential Organ Failure Assessment, Vincent J. L. et al., 1996) :. 42, 10, 20, 4, 2 (NIHON KOHDEN 6410, ) 6 2 ( 3 )., -,,
10 8,, -. - Windows XP STATISTICA 6.0 (Stat Soft, GS-35F-5899H), MedCalc (version ), (Me), (Min) (Max), 25- (Q1) 75- (Q3), 95% - (95% ). -. ( - ), ² ² ( ). (ROC- ). - <0,05 [.., 2006]. - (n=151) 67 (44,4%; 95% 36,5 52,3%), -, 83., (n=308), (41,9%; 95% 36,3 47,6%), - 185, (n=70) 24 (34,3; 95% 23,2 45,4), 30. ( 2 =1,37, =0,242). 1 -.,,,, [Caly W. R., 1993, Fernández J., 2002]. (n=18, 5,8%).,, -
11 9, ( - ) (%; 95% ) n=151.. ( ). ( ) (%; 95% ) n=308 (%; 95% ) n= ,5 (14,1 26,9) 27 8,8 (5,9 12,5) 7 10,0 (4,1 19,5) 24 15,9 (10,1 21,7) 97 31,5 (26,3 37,0) 12 17,0 (9,2 28,0) 6 n= ,5 (2,6 18,5) 2,6 (1,1 5,1) 1 1,0 1 0,7 (0-2,0) 13 4,2 (2,3 7,1) n=29 21,0 (8,0 40,0) 5 3,3 (1,0 6,2) 7 2,3 (0,6 3,9) 4 5,7 (0,3 11,2) 10 6,6 (2,7 10,1) 33 10,7 (7,3 14,2) 6 8,6 (2,0 15,1) : 0 3 2,0 (0,4 5,7) ,3 (0,9 4,6) 5,8 (3,5 9,1) 0 2 3,0 (0,4 9,9) 36,9% 28,6% 1,2% 6,0% 15,5% 20,9% 75,2% 10,1% 5,4% 28,7% 29,0% 50,0% 16,7% 42,0% 0% 20% 40% 60% 80% 100% 1.,, -,, (10,5%, 95% 4,0 21,5). - 8 (2,6%; 95% 1,1 5,1) -
12 10 (, ) ( - ),.,. - (12 16, 75%), Enterobacteriaceae. - 56% (9 16) 3 -, 4%, (8 10, 80%), Staphylococcaceae. - 15% %. Enterobacteriaceae (n=7), (n=3) (n=4). + 14% (n=4). 36% (n=10). Aspergillus. 2 Candida spp. 7 Candida. 13 (46%), 12 -, 4 (P. Aeruginosa + P. vulgaris + E. oli + S. aureus). -, Candida,., (48,7%).,
13 11 (30,0%) - (53,2%), (O =0,4; 95% 0,2 0,6; 2 =16,96, <0,001).,,, - (U [150;158] =9772,5; =0,008). -, ; 7 ( 2). 2.,, ,3%, 2 32,1% =4,1; 95% 1,3 13,4; =0,014). 7 ( 2 ) ( =9,7, 95% 2,5 38,3; <0,001). -, 2 (60,0% 27,3%; =4,0; 95% 1,7 9,3; p=0,001) 7 (56,2% 27,3%; =3,4; 95% 1,4 8,2; p=0,001) ( 2 ). 45,3% (95% 38,5 52,3),,
14 12 49,3% (95% 40,8 57,8), 37,1% (95% 25,9 49,5)., (77,0%; 95% 65,6 86,3), 11 (16,0%; 95% 8,1 26,4), 5 (7,0%; 95% 2,4 15,9) (66,9%), 56,8% (n=42; 72,4%) (n=28, 33,3%; =5,3; 95% 2,5 10,9, 2 =20,96, <0,001). - ( =4,0; 95% 1,5 11,3, 2 =7,02, =0,008). - CLIF-C ACLF (29,1%; 95% 22,0 37,1%). - ACLF (57,0% 39,0%, =0,070). ACLF (2 3 ) - ( =8,2; p=0,045). 8,2 ( =0,045). - Child-Pugh CLIF-C ( 3) Sensitivity a CLIF-C Child-Pugh Specificity 3. ROC- CLIF-C
15 13 Child-Pugh : ) 100% (95% 54,1 100), ( ) 29,5% (95% 18,5 42,6). CLIF-C: 100% (95% 58,9 100), 88,5% (95% 77,8 95,2). CLIF-C Child-Pugh ( ( )=0,97, 95% 0,89 0,99 =0,66, 95% 0,54 0,77, =0,015). ( ) 6 (10,5%; 95% 2,6 18,5, n=57) ( 2) Uristik (3+) 70 (2+) Raoultella terrigena (4+) 500 (4+) (4+) 500 (4+) (3+) 125 (3+) (2+) 15 (1+) Streptococcus pyogenes (1+) 0 Staphylococcus xylosus (3+) (3+),,., 3 ( 4 ) -.,, - ( 1)., (n=57)., -. (r=0,880, 95% 0,804 0,928, <0,001), -. - : % (95% 40,2 100,0),
16 14 86,8% (95% 74,7 94,5), - ( ) 7,57 (95% 6,8 8,4), - ( ) ( ), ( ) 36,4% (95% 11,2 69,1), ( ) 100,0% (95% 92,2 100,0), ( ) 87,7%., - 900, 75% (95% 20,3 95,9), 100% (95% 93,2 100,0), (0), 0,25 ( ), 100% (95% 30,5 100,0), 98,1% (95% 90,1 99,7), 98,2%., -. 2 (URIstik 10 ). 1+, URIstik A10 > 2, 10 > 1. - > 3. URIstik,, URIstik (p=0,914; =0,902; =0,743, ) ( ) , - ( ) [35]. - ( ) ( URIstik 10, 10,, 2016) ,4%, 41,9%, 34,3%. - (75%) -
17 15 Enterobacteriaceae. 56% - 3, 4%. - +, - Staphylococcaceae. 15,0%.,, (68%), - (46%) + [3, 4, 5, 6, 7, 12, 13, 16, 18, 22, 24, 25, 27, 31, 33] ,3% 37,1%., - 77,0% -, 16,0% -, 7,0% ,8%. =5,3; <0,001), 6,6 ( <0,001) [5, 12, 13, 14, 29, 32, 34] ,7% (, 83,3%) 21,4%. - 7 ) 10- ( =9,7, 95% 2,5 38,3; <0,001) [12, 13, 19]. 4., - 29,1%. (2 3 ) ( =8,2; =0,045). 8, CLIF-C Child-Pugh ( - =0,97, 95% 0,89 0,99 =0,66, 95% 0,54 0,77, =0,015) [5, 10, 12, 13, 14, 17, 30]. 5. ( ) 10,5%.
18 (ROC- ): 400 ( 100% (95% 40,2 100,0), - 86,8% (95% 74,7 94,5) 87,7%) ( 75% (95% 20,3 95,9), 100% (95% 93,2 100,0) 98,2%). - - URIstik A10 > 2 ( - 0,976, 95% 0,896 0,997, p<0,001), 10 - > 1 ( 0,960, 95% 0,871 0,993, p<0,001)., -,, ( ) [9, 11, 12, 20, 21, 23, 26, 28, 35, 36]. 1.,, (, ). 2. CLIF-C -. 3., (URIstik 10 [35,36]) , [35].
19 17 1.,.. - /.. // ,.. : /.. // ARSMedica ,.. /.. // ,.. /.. // ,.. - /..,..,.. // ,.. /.. // ,.. /.. // ,.. - /. // ,.. : - /.. // ,.. - /..,.. // ,.. : -, /.. // ,.. : - - (2013) /.. // ,.. : /.. - //
20 18 14.,.. : /..,.. // ,.. - /.. // , /..,.. // ,.. CLIF-C /..,.. // /..,.. -,..,.. // ,.. /..,.. // /..,..,..,.. // :.-..,. 50-,, / ;..... :, : - ( ) /..,..,..,..,..,.. - // - :..-..,, :, ,.. - // :,, : II :..-..,. 50-.
21 19..., /..... :, /..,..,..,.. // - :,, - : 9-.,, /.... :, ,.., ( ) /.. - // : , ,, : 4. /... ;.:.. [.]. :, ,.. : // III - :..-.. /..... :, ,.. /.. // : -,, : 10-.,, /.... :, ,.. - /.. // VII (, ): 3. 1 /...,..,... :, Haurilenka, D. Morphological features of spontaneous bacterial peritonitis in cirrhotic patients // Liver Disease In Resource Limited Settings (May 29 30, 2015, Bucharest, Romania): EASL Monothematic Conference. Abstracts. Poster abstracts. N P Haurilenka, D. Infection-associated acute tubular necrosis in critically ill patients with cirrhosis // Addressing end-stage liver disease: A multifaceted challenge (September 25 27, 2015, Glasgow, United Kingdom): EASL Special Conference. Abstracts. Poster abstracts. N P12.
22 Haurilenka, D. The precipitating factors of acute-on-chronic liver failure in hospitalized patients: A single center retrospective study in Belarus / D. Haurilenka, N. Silivontchik // Highlights from Hepatology 2015: From Chronic Hepatitis to Hepatocellular Carcinoma (Oktober 14 15, 2015, Freiburg, Germany): Falk Symposium 199. Abstracts. Poster abstracts. N Haurilenka, D. Etiology of culture-positive bacterial infections in hospitalized cirrhotic patients // Highlights from Hepatology 2015: From Chronic Hepatitis to Hepatocellular Carcinoma (Oktober 14 15, 2015, Freiburg, Germany): Falk Symposium 199. Abstracts. Poster abstracts. N Haurylenka, D. Acute tubular necrosis in cirrhotic patients who meet the criteria of hepatorenal syndrome / D. Haurylenka, N. Silivontchik // R ga Stradi š University. Research articles in medicine & pharmacy Suppl. I: Abstracts from VII Latvian Gastroenterology Congress with International participation [5 December 2015, R ga, Latvia]. R ga: RSU, P Silivontchik, N. Bacterial infections in alcoholic liver cirrhosis / N. Silivontchik, D. Haurylenka // Congress Gut-Liver Interactions: From IBD to NASH [11 12 March, 2016, Innsbruck, Austria] P Haurylenka, D. Infection-associated acute tubular necrosis in critically ill patients with cirrhosis / D. Haurylenka // J. Hepatol Vol.64. P : : /..,.. -,..,..,..,..,..,..,..., : , G 01N 33/50 ( ) /..,..,..,..,..,.. ;..,.. -,..,..,.., ; ; //. /.. i
23 21 : : i ( ), ( ),,,. : i i, i. :,,,,,. : i,,,,. : 44,4% (n=67; 95% I 36,5 52,3%), 41,9% (n=129; 95% I 36,3 47,6), 34,3% (n=24; 95% I 23,2 45,4%). i 7 i 10 ( =9,7, 95% 2,5-38,3, <0,001).,.. :,, i.),. :,,.
24 22 : : ( ), ( ),,,. : - -,. :,,,,,. :,,,,. - : - 44,4% (n=67; 95% 36,5 52,3%), 41,9% (n=129; 95% 36,3 47,6), 34,3% (n=24; 95% 23,2 45,4%) ( = 9,7, 95% 2,5 38,3, <0,001). -, :,,.), -. :,, -.
25 23 SUMMARY Dzmitry Haurylenka Bacterial infections in liver cirrhosis: clinical manifestation and outcomes in outpatients and inpatients Keywords: liver cirrhosis (LC), spontaneous bacterial peritonitis (SBP), infectious complications, acute kidney injury, liver failure. Objective: to optimize strategy of management the patients with LC and bacterial infections, by improving diagnostic methods, identifying features and clinical consequences of bacterial infections. Methods: clinical, laboratory, instrumental, morphological, molecular-genetic, statistical. The results obtained and their novelty: clinical features and outcome of infectious complications in patients with LC, including groups with kidney injury, with upper gastrointestinal bleeding, outpatient dead is carried out. Various infections are common in patients with LC: in gastroenterology department 44,4% (n=67; 95% CI %) among the died in hospital 41,9% (n=129; 95% CI ), among the ambulatory dead 34,3% (n=24; 95% CI %). While in the hospital more than 7 days after the episode of gastrointestinal bleeding risk of infectious complications in patients with liver cirrhosis increased 10-fold (OR = 9.7, 95% CI , p <0.001). The method of diagnosis of SBP in patients with liver cirrhosis and ascites, and diagnostic algorithm were developed and implemented. In order to predict in-hospital mortality in patients with liver cirrhosis and infectious complications estimated the diagnostic value of the scale to determine the degree of organ dysfunction. Recommendations for use: the algorithm for diagnostics of SBP in patients with LC can be used doctors of all specialties (internist, gastroenterologist, surgeon etc.), dealing with diagnostics and treatment of liver diseases. Applications: gastroenterology, internal and infectious diseases.
26 /16... «Times».... 1, , :».,, 1/ , 6, ,.
Acute on Chronic Liver Failure: Current Concepts. Disclosures
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