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2996860 
Journal Article 
Increased risk of cognitive impairment in cirrhotic patients with bacterial infections 
Merli, M; Lucidi, C; Pentassuglio, I; Giannelli, V; Giusto, M; Di Gregorio, V; Pasquale, C; Nardelli, S; Lattanzi, B; Venditti, M; Riggio, O 
2013 
Yes 
Journal of Hepatology
ISSN: 0168-8278
EISSN: 1600-0641 
59 
2 
243-250 
English 
23523580 
WOS:000322097400008 
BACKGROUND & AIMS: A causal relationship between infection, systemic inflammation, and hepatic encephalopathy (HE) has been suggested in cirrhosis. No study, however, has specifically examined, in cirrhotic patients with infection, the complete pattern of clinical and subclinical cognitive alterations and its reversibility after resolution. Our investigation was aimed at describing the characteristics of cognitive impairment in hospitalized cirrhotic patients, in comparison with patients without liver disease, with and without infection.

METHODS: One hundred and fifty cirrhotic patients were prospectively enrolled. Eighty-one patients without liver disease constituted the control group. Bacterial infections and sepsis were actively searched in all patients independently of their clinical evidence at entry. Neurological and psychometric assessment was performed at admission and in case of nosocomial infection. The patients were re-evaluated after the resolution of the infection and 3months later.

RESULTS: Cognitive impairment (overt or subclinical) was recorded in 42% of cirrhotics without infection, in 79% with infection without SIRS and in 90% with sepsis. The impairment was only subclinical in controls and occurred only in patients with sepsis (42%). Multivariate analysis selected infection as the only independent predictor of cognitive impairment (OR 9.5; 95% CI 3.5-26.2; p=0.00001) in cirrhosis. The subclinical alterations detected by psychometric tests were also strongly related to the infectious episode and reversible after its resolution.

CONCLUSIONS: Infections are associated with a worse cognitive impairment in cirrhotics compared to patients without liver disease. The search and treatment of infections are crucial to ameliorate both clinical and subclinical cognitive impairment of cirrhotic patients. 
Hepatic encephalopathy; Minimal hepatic encephalopathy; Sepsis; Systemic inflammatory response syndrome (SIRS); Hyperammonemia; Psycometric test