Trends, Burden, and Impact of Infections Among Hospitalized Patients With Cirrhosis

Background: Cirrhosis is associated with immune dysfunction, which increases susceptibility to bacterial infections and contributes significantly to patient morbidity and mortality. Understanding the burden and impact of infections in this population is essential for improving outcomes and reducing health care costs. Methods: We analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2022, identifying adult patients hospitalized with cirrhosis. Patients were stratified based on the presence or absence of infections. Collected variables included patient demographics, etiology of cirrhosis, decompensation status, and adverse outcomes. Multivariate logistic and linear regression analyses were used to evaluate the impact of infections on clinical outcomes and health care utilization. Results: Among 5,061,228 patients with cirrhosis, 1.51 million (30%) developed infections. The infected group was predominantly 45 to 65 years old (48.2%), male (54%), and White (68%). Common infections included urinary tract infections (11.5%), pneumonia (9.6%), skin and soft tissue infections (6.2%), spontaneous bacterial peritonitis (3.2%), Clostridioides difficile infection (1.8%), and cholangitis (0.8%). Compared with patients without infections, infected patients had higher rates of in-hospital mortality (9.7% vs. 4.7%), sepsis (31.6% vs. 6.9%), acute kidney injury (39.4% vs. 26.8%), ICU admissions (12.5% vs. 6.1%), deep vein thrombosis (2.1% vs. 1.2%), and pulmonary embolism (1% vs. 0.7%). Conclusions: Infections substantially worsen clinical outcomes and increase health care burden among hospitalized patients with cirrhosis. Early identification, preventive strategies, and prompt management of infections are critical to improving prognosis and reducing associated health care costs.