Non-Necrotizing Acute Dermohypodermal Infections in Cirrhotic Patients Being Evaluated for Liver Transplantation

Authors

  • Vitoria Caroline Moreno dos Santos Faculdade de Medicina de São José do Rio Preto – Hospital de Base – Unidade de Transplante de Fígado - São José do Rio Preto (SP) – Brazil. https://orcid.org/0000-0003-0614-4470
  • Olívia S. Cretelli Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil.
  • Linoel Curado Valsechi Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil. https://orcid.org/0000-0002-9508-6198
  • Matheus B. Meirelles Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil.
  • Gustavo Marcatto Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil.
  • Lincoln B. da Silva-Isepon Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil. https://orcid.org/0000-0002-4689-4738
  • Priscilla Itimura Faculdade de Medicina de São José do Rio Preto – São José do Rio Preto (SP) – Brazil.
  • Patrícia da Silva-Fucuta Faculdade de Medicina de São José do Rio Preto – Hospital de Base – Serviço de Gastro-Hepatologia – São José do Rio Preto (SP) – Brazil. https://orcid.org/0000-0002-8342-4970
  • Renato Ferreira da Silva Faculdade de Medicina de São José do Rio Preto – Hospital de Base – Unidade de Transplante de Fígado - São José do Rio Preto (SP) – Brazil. https://orcid.org/0000-0001-9652-6426

Keywords:

Bacterial Infections, Soft Tissue, Cirrhosis, Immunodeficiency, Mortality

Abstract

Introduction:  Infections in cirrhotic patients have a significant impact on morbidity and mortality, but little is known about acute non-necrotizing dermohypodermal infections (erysipelas and infectious cellulitis) in this population. The high mortality in this group also represents a loss of opportunity for liver transplantation, which could be a potential solution for these patients. Objectives:  This study aims to describe the clinical characteristics, evolution, and outcomes of cirrhotic patients with acute non-necrotizing dermohypodermal infections under evaluation for liver transplant. Methods:  A retrospective study was conducted on patients hospitalized with cirrhosis and dermohypodermal infections from 2010 to 2012. Results:  Among 983 patients with liver cirrhosis, leading to 2,046 consultations for decompensated cirrhosis, dermohypodermal infections were identified in 65 (7%) cases. The mean age was 58 years (± 10), with 82% male. Cellulitis predominantly affected the lower limbs (70%), followed by the trunk (21%) and upper limbs (9%). Alcoholic liver disease was the primary etiology (56%), followed by alcohol and hepatitis C (17%), isolated hepatitis C (13%), non-alcoholic steatohepatitis (9%), and hepatitis B (3%). Based on the Child-Pugh score, 8% were classified as class A, 46% as class B, and 46% as class C. The average model for end-stage liver disease (MELD) score was 20 (± 8). Commonly associated infections included urinary tract infection (54%), pneumonia (25%), and spontaneous bacterial peritonitis (21%). Prescribed antibiotics were clindamycin (71%), cephalosporins (40%), oxacillin (18%), penicillin (11%), vancomycin (11%), quinolones (4.5%), and other antibiotics (15.3%). Sepsis occurred in 14% of cases, and the mortality rate was 18.5% (n=12). Among the deceased patients, 67% (n=8) had concomitant infections with cellulitis. Factors significantly associated with mortality were concomitant infections (69 vs. 31%, p = 0.02) and elevated C-reactive protein levels (6 vs. 3 mg/dL, p = 0.03). Conclusion:  This study highlights the high hospital mortality rate among cirrhotic patients with acute non-necrotizing dermohypodermal infections, especially when concomitant infections are present. The high mortality not only reflects the severity of the condition but also represents a loss of opportunity for potentially life-saving interventions, such as liver transplantation. Further research is needed to improve the management of cirrhotic patients with dermohypodermal infections.

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Published

2025-03-17

How to Cite

1.
Santos VCM dos, Cretelli OS, Valsechi LC, Meirelles MB, Marcatto G, Silva-Isepon LB da, et al. Non-Necrotizing Acute Dermohypodermal Infections in Cirrhotic Patients Being Evaluated for Liver Transplantation. bjt [Internet]. 2025 Mar. 17 [cited 2025 Mar. 30];28. Available from: https://bjt.emnuvens.com.br/revista/article/view/640

Issue

Vol. 28 (2025)

Section

Original Paper

License

Copyright (c) 2025 Vitoria Caroline Moreno dos Santos, Olívia S. Cretelli, Linoel Curado Valsechi, Matheus B. Meirelles, Gustavo Marcatto, Lincoln B. da Silva-Isepon, Priscilla Itimura, Patrícia da Silva-Fucuta, Renato Ferreira da Silva

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This work is licensed under a Creative Commons Attribution 4.0 International License.