Abstract Rationale Diagnosing infections in critically ill patients with cirrhosis is believed to be challenging due to alterations in physiology including baseline hypotension, impaired lactate clearance, and abnormal thermoregulation. We hypothesized that, at the time of admission to the intensive care unit (ICU), traditional physiologic markers would poorly predict the development of culture confirmed infections in critically ill patients with cirrhosis, possibly contributing to delayed antibiotic administration. Methods We retrospectively investigated all adults with cirrhosis, identified using validated ICD-10 methodology, admitted to an ICU throughout a 5-hospital academic health system between 2017-2025. We excluded patients already known to have positive cultures prior to ICU admission, as well as patients transferred from outside hospitals and emergency departments. Patients were followed from the 24 hours before through the 96 hours after ICU admission. Data on physiologic parameters and culture results were automatically extracted from the electronic health record. We used logistic regression to investigate the association of physiologic parameters from the 24 hours prior to ICU admission with the primary outcome of a positive blood or ascites culture collected during follow-up. Our secondary outcome was the administration of early broad-spectrum antibiotics, both continued and newly initiated, within 48 hours of ICU admission. Results We identified 1,331 critically ill patients with cirrhosis after exclusions. The median age was 60 years (IQR 50-68), with 38% female (n = 509) and 64% White (n = 844) patients. Overall 30-day and 90-day mortality were 20% (n = 270) and 28% (n = 368) respectively. The results of logistic regression are listed in Table 1. The incidence of culture positivity was 12% (n = 154). All physiological parameters except for leukopenia were statistically associated with the development of positive cultures. The incidence of early broad-spectrum antibiotic administration was 49% (n = 650). Elevated temperature was the single greatest predictor of early broad-spectrum antibiotic administration. Among the 154 patients with positive cultures, 20% (n = 30) did not receive early antibiotics. Elevated temperature was absent in all patients with positive cultures who did not receive early antibiotics. Conclusion Traditional physiologic markers at the time of ICU admission are predictive of the short-term development of positive blood and ascites cultures in critically ill patients with cirrhosis. Despite this, 20% of patients who develop positive cultures do not receive early broad-spectrum antibiotics. Critically ill patients with cirrhosis who lack fever at presentation are at increased risk of having antibiotics inappropriately withheld. Additional investigations are needed to understand the performance characteristics of Sepsis-3 definitions in this population. This abstract is funded by: NHLBI: 1F32HL182325-01
Davis et al. (Fri,) studied this question.