Main Article Content

Murad Baig
Mashhood Sulaman
Muhammad Muizz Hassan
Ahmed Aftab
Akashnath Kivalur Ganeshanath
Muhammad Munawar
Saifullah Syed
Kamel J. K. Walwil
Jumana Abdelrahman Diab
Hosam Alazazzi


Cirrhosis, Bacteremia, Variceal Bleeding, Risk factor


Background and Aim: Rupture and bleeding from gastroesophageal reflux veins (GEVs) represent major complications for individuals with chronic liver disease (CLD), often leading to high mortality. The present study aimed to evaluate the bacteremia as a risk factor in cirrhotic patients suffering from variceal upper gastrointestinal tract bleeding.

 Patients and Methods: This cross-sectional study investigated 88 cirrhotic patients in the Department of Internal Medicine, Tertiary Care Hospital, Lahore from January 2022 to April 2024. Patients aged 20 to 60 years of either gender with liver cirrhosis disease were included. All the patients were grouped into three groups; Group-I (first attack), Group-II (recurrent attack), and Group-III (control or no history of variceal bleeding).  Eligible patients underwent history taking, complete physical examination, and laboratory investigations. Upper GI endoscopy, pro-calcitonin level measurement in blood, and blood culture were done.  Data analysis was done using SPSS version 26.

 Results: The overall mean age was 52.8 ± 8.62 years. Out of 88 patients, there were 54 (61.4%) male and 34 (38.6%) female. Patient’s distribution in groups were as follows; Group-I 32 (36.4%), Group-II 32 (36.4%), and Group-III 24 (27.2%). The incidence of positive blood culture such as Escherichia coli, Staphylococcus auerus, and Klebsiella in Group-I, Group-II, and Group-III was 15 (46.9%), 20 (62.5%), and 6 (25%), respectively whereas the rate of positive Procalcitonin (ng/ml) was 14 (43.8%), 19 (59.4%), and 5 (20.8%) respectively. The highest percentage of positive blood cultures was observed in Group-II, followed by Group-I, and a control group and, Patients with recurrent venous hemorrhage showed statistically higher PCT values ​​compared with first-time venous hemorrhage and the control group.

 Conclusion: The present study observed that bacteremia and elevated procalcitonin levels are risk factors in patients with cirrhosis. Procalcitonin may serve as a surrogate biomarker for variceal bleeding and bacteremia.

Abstract 114 | pdf Downloads 34


1. Zidan MH, Zaghloul SG, Seleem WM, Ahmed HS, Gad AI. Bacteremia as a risk factor for variceal upper gastrointestinal tract bleeding in cirrhotic patients: a hospital-based study. Egyptian Liver Journal. 2021 Dec;11:1-7.
2. Shih HA, Tsai PC, Wu KH, Chen YT, Chen YC. Bacteremia in cirrhotic patients with upper gastrointestinal bleeding. Turk J Gastroenterol 2018; 29: 164-9.
3. Kumar JR, Duraisingam A, Kamil M. a study of etiology, clinical profile and predictive factors for development of spontaneous bacterial peritonitis among patients with cirrhosis of liver in a tertiary care hospital in chennai.
4. Kothari HG, Gupta SJ, Gaikwad NR et al (2019) Role of non-invasive markers in prediction of esophageal varices and variceal bleeding in patients of alcoholic liver cirrhosis from central India. Turk J Gastroenterol 30(12):1036–1043.
5. Neofytos D, Treadway S, Ostrander D et al (2013) Epidemiology, outcomes, and mortality predictors of invasive mold infections among transplant recipients: a 10-year, single-center experience. Transpl Infect Dis 15(3):233–242.
6. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007;46: 922-38.
7. Cremers I, Ribeiro S. Management of variceal and nonvariceal upper gastrointestinal bleeding in patients with cirrhosis. Therap Adv Gastroenterol 2014; 7: 206-16.
8. D’Amico G, De Franchis R; Cooperative Study Group. Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology 2003; 38: 599-612.
9. Hsu YC, Liou JM, Chung CS, et al. Early risk stratification with simple clinical parameters for cirrhotic patients with acute upper gastrointestinal bleeding. Am J Emerg Med 2010; 28: 884-90.
10. Moon AM, Dominitz JA, Ioannou GN, Lowy E, Beste LA. Use of antibiotics among patients with cirrhosis and upper gastrointestinal bleeding is associated with reduced mortality. Clin Gastroenterol Hepatol 2016; 14: 1629-37.
11. Fernández J, Acevedo J. New antibiotic strategies in patients with cirrhosis and bacterial infection. Expert Rev Gastroenterol Hepatol 2015; 9: 1495-500.
12. Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review. Aliment Pharmacol Ther 2011; 34: 509-18.
13. Tandon P, Abraldes JG, Keough A, et al. Risk of bacterial infection in patients with cirrhosis and acute variceal hemorrhage, based on child-pugh class, and effects of antibiotics. Clin Gastroenterol Hepatol 2015; 13: 1189-96.e2.
14. Fernández J, Acevedo J, Castro M, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012; 55: 1551-61.
15. Bunchorntavakul C, Chavalitdhamrong D. Bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. World J Hepatol 2012; 4: 158-68.
16. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: A critical review and practical guidance. World J Hepatol 2016; 8: 307-21.
17. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60: 1310-24.
18. Merli M, Lucidi C, Pentassuglio I, et al. Increased risk of cognitive impairment in cirrhotic patients with bacterial infections. J Hepatol 2013; 59: 243-50.
19. Garcia-Tsao G, Bosch J. Varices and variceal hemorrhage in cirrhosis: a new view of an old problem. Clin Gastroenterol Hepatol 2015; 13: 2109-17.
20. Bartoletti M, Giannella M, Lewis RE, Viale P. Bloodstream infections in patients with liver cirrhosis. Virulence 2016; 7: 309-19.
21. Kuo MT, Yang SC, Lu LS, et al. Predicting risk factors for rebleeding, infections, mortality following peptic ulcer bleeding in patients with cirrhosis and the impact of antibiotics prophylaxis at different clinical stages of the disease. BMC Gastroenterol 2015; 15: 61.
22. Bartoletti M, Giannella M, Caraceni P, et al. Epidemiology and outcomes of bloodstream infection in patients with cirrhosis. J Hepatol 2014; 61: 51-8
23. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 2004; 40: 652-9.
24. Lee SH, Chan RC, Wu JY et al (2013) Diagnostic value of procalcitonin for bacterial infection in elderly patients: a systemic review and meta-analysis. Int J ClinPract 67(12):1350–1357

Most read articles by the same author(s)

1 2 > >>