Sepsis and Chronic Liver Disease: Mortality and Prognostic Factors. A 12-Year Retrospective Analytical-Descriptive Observational Study

Introduction. Patients with chronic liver disease are at increased risk of developing infections and sepsis. Although high mortality in this context is well documented, the prognostic factors associated with poorer survival in patients admitted to the ICU have not been fully defined. Objective. To describe the characteristics of critically ill patients with chronic liver disease and sepsis, to determine mortality, and to analyze the factors associated with a poorer prognosis. Methods. An observational, retrospective, descriptive and analytical study of a cohort of patients with chronic liver disease and a diagnosis of sepsis admitted to the ICU at the Hospital Clínico Universitario Lozano Blesa, in Zaragoza, Spain, between 2012 and 2023. Results. A total of 71 patients were included, 69% were male, and 51% had alcohol-related liver disease. In the bivariate analysis, higher Child-Pugh and MELD scores at admission, elevated bilirubin and INR levels, as well as the type of infection, were associated with a poorer prognosis. The ICU mortality rate was 54.9%. Independent predictors of mortality were a higher MELD score at admission (OR: 1.21; 95% CI: 1.02–1.45), Gram-positive bacterial infection (OR: 7.58; 95% CI: 1.95–29.50), and fungal infection (OR: 7.36; 95% CI: 2.10–25.75). Conclusion. Sepsis in patients with chronic liver disease is associated with high mortality. A higher MELD score at admission and the presence of Gram-positive bacterial or fungal infections were identified as independent prognostic factors for death.