Interobserver Agreement for Classifying Infections in Patients with Decompensated Cirrhosis Based on Centers for Disease Control and Prevention Criteria

Background::Bacterial infections are common in patients with decompensated cirrhosis, largely owing to bacterial translocation and cirrhosis-associated immune dysfunction. This study aims to determine the reliability for classifying infections in patients with decompensated cirrhosis based on the Centers for Disease Control and Prevention (CDC) criteria.Methods::The patients with decompensated cirrhosis with suspicious infection in a registered prospective cohort of cirrhosis from May 1, 2014 to February 25, 2015 in the ward of First Affiliated Hospital of Zhejiang University were retrospectively identified. Agreement assessment was conducted focusing on site of infection, the possibility of infection, and pathogens of infection on both system level and specific diagnosis level. A subgroup analysis was performed based on with/without acute-on-chronic liver failure (ACLF).Results::A total of 402 infectious episodes among 351 patients were enrolled for consistency analysis. The overall agreement for site of infection was 94% (378/402) ( k= 0.90, 95% CI 0.86-0.94) on system level and 86% (346/402) ( k= 0.84, 95% CI 0.80-0.88) on specific diagnosis level. On possibility of infection, the overall agreement was 81% (306/378) (weighted k= 0.71, 95% CI 0.65-0.77), with 84% (224/267) (weighted k= 0.75, 95% CI 0.63-0.87) in patients with ACLF and 80% (70/88) (weighted k= 0.68, 95% CI 0.60-0.76) in patients without ACLF, respectively. On pathogens of infection, the overall agreement was 72% (60/83) ( k = 0.70, 95% CI 0.60-0.80) among most frequent infections. Conclusion::The agreement for classifying infections in patients with decompensated cirrhosis based on CDC criteria is acceptable overall, suggesting that it can be a useful tool for clinical management in patients with decompensated cirrhosis with suspicious infections.