Predictor of gram-negative bacteremia in cirrhotic patients with skin and soft-tissue infections

Hung Sheng Wang, Cheng Ting Hsiao, Wen Chih Fann, Chia Peng Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


Cirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of skin and soft-tissue infections (SSTIs). Cirrhotic patients with SSTIs have a dramatically increased mortality. To recognize the risk factors of gram-negative infections are critical for improving survival rate. A retrospective cohort study of hospitalized cirrhotic patients with SSTIs and gram-negative bacteremia (GNB) was conducted in 2 tertiary hospitals in southern Taiwan between March 2015 and January 2020. Another group were matched by controls with non-GNB based on time, demographics and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Receiver operating curve and the area under the curve were used to evaluate its discriminating ability. A total of 186 patients were included, 62 in GNB group and 124 in non-GNB group. Comorbidities that were significant risk factors for gram-negative bacteremia included acute kidney injury. Significant risk factors evident in laboratory evaluations included higher model for end-stage liver disease score, higher serum lactate, higher C-reactive protein and higher creatinine level. This study found acute kidney injury, or those exhibiting hyperlactatemia (>16 mg/dL), high MELD score (>14), high CRP (>50 mg/dL), and high creatinine (>2.0 mg/dL) were risk factors associated with gram-negative bacteremia. Cirrhotic patients with SSTIs with aforementioned risk factors should pay more attention by clinicians due to higher mortality.

Original languageEnglish
Pages (from-to)E34075
JournalMedicine (United States)
Issue number28
StatePublished - 14 07 2023

Bibliographical note

Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.


  • SSTIs
  • cirrhosis
  • gram-negative pathogen
  • mortality
  • Creatinine
  • Severity of Illness Index
  • Liver Cirrhosis/complications
  • Bacteremia/etiology
  • Gram-Negative Bacterial Infections/complications
  • Soft Tissue Infections/complications
  • Humans
  • Risk Factors
  • End Stage Liver Disease/complications
  • Retrospective Studies


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