TOPLINE:

In patients with liver cirrhosis, the risk for infections was higher around the time of diagnosis compared with 4 years before diagnosis, with an increased risk observed in patients with decompensated cirrhosis and those with alcohol-related liver disease.

METHODOLOGY:

• Researchers conducted a retrospective case series study using data from the Swedish National Patient Register, analysing 42,067 patients with cirrhosis (median age at diagnosis, 65 years; 65% men) in Sweden (1997-2020).
• They compared incidence rates of infection between a pre-diagnostic baseline period (4 years prior to diagnosis) and a diagnostic period (3 months before and 3 months after the diagnosis of cirrhosis).
• Cirrhosis was classified as compensated or decompensated; decompensated cirrhosis was defined by specific diagnostic codes for ascites, oesophageal variceal bleeding, hepatorenal syndrome, or hepatic encephalopathy.
• Aetiologies at or before diagnosis were categorised as autoimmune liver disease, rare liver diseases, alcohol-related liver disease, and others.
• Infection subtypes were grouped into seven anatomical categories: sepsis; ear, nose, and throat or respiratory tract infections; gastrointestinal and abdominal infections (excluding peritonitis); urinary tract infections; musculoskeletal, skin, and connective tissue infections; peritonitis (including spontaneous bacterial peritonitis); and unspecified.

TAKEAWAY:

• The incidence rate ratio (IRR) for infections was 15.7-fold higher during the diagnostic period (95% CI, 14.7-16.9) and 6.8-fold higher during the post-diagnostic period (95% CI, 6.3-7.3) than during the pre-diagnostic period.
• The largest increase in risk during the diagnostic period was noted for peritonitis (IRR, 51.4; 95% CI, 33.9-77.8), followed by sepsis (IRR, 27.9; 95% CI, 22.5-34.6) and urinary tract infections (IRR, 15.3; 95% CI, 13.3-17.6).
• Patients with decompensated cirrhosis had a 17.2-fold higher risk for infection (IRR, 17.2; 95% CI, 15.6-18.9) during the diagnostic period, with those with ascites having the greatest increase (IRR, 21.4; 95% CI, 18.7-24.4).
• When considering cirrhosis aetiologies, patients with alcohol-related liver disease had the highest increase in infection risk during the diagnostic period (IRR, 19.2; 95% CI, 17.1-21.5).

IN PRACTICE:

"These findings support that infections preceding diagnosis of cirrhosis act as clinical indicators of underlying cirrhosis, as previously asymptomatic cirrhosis is diagnosed when patients seek medical care for other reasons, such as a serious infection," the authors of the study wrote. "Implementing prevention strategies is therefore essential to improving prognosis and reducing mortality, and needs to be prioritized immediately following a diagnosis of cirrhosis," they added.

SOURCE:

This study was led by Pia Anna Steimer, Karolinska Institutet, Stockholm, Sweden. It was published online on March 10, 2026, in European Journal of Internal Medicine.

LIMITATIONS:

The study captured only severe infections because the register lacked primary care data where less severe infections may have been managed. The diagnostic period estimates were subject to detection bias and possible outcome misclassification due to the 30-day rule for defining separate infections. High mortality linked to decompensated cirrhosis may have led to the underestimation of post-diagnostic infection risk.

DISCLOSURES:

Several authors reported being supported by grants and funds from multiple institutions and foundations including the Ruth and Richard Julin Foundation, the Swedish Research Council, and Mag-Tarmfonden. One author reported receiving institutional research funding and serving as a consultant, on advisory boards, and on hepatic events adjudication committees for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.