Volume 139, Issue 4, Pages 1246-1256.e5 (October 2010) Infections in Patients With Cirrhosis Increase Mortality Four-Fold and Should Be Used in Determining Prognosis  Vasiliki Arvaniti, Gennaro D'Amico, Giuseppe Fede, Pinelopi Manousou, Emmanuel Tsochatzis, Maria Pleguezuelo, Andrew Kenneth Burroughs  Gastroenterology  Volume 139, Issue 4, Pages 1246-1256.e5 (October 2010) DOI: 10.1053/j.gastro.2010.06.019 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 Odds ratio (random effects model), log scale, for the risk of death in patients with and without infection, respectively, in studies reporting complete information on mortality. Each study is identified by the name of the first author, year of publication, and corresponding reference number. Squares indicate the odds ratio per each trial and the size of the squares is proportional to the weight of trials. The horizontal bars denote the 95% confidence intervals of the odds ratios. The vertical solid line is the equivalence line, where the odds ratio is equal to 1. Odds ratios on the left of the equivalence line denote higher mortality in patients without infection whereas those on the right denote higher mortality with infection. The vertical dashed line represents the pooled odds ratio of the whole set of studies. The diamond represents 95% confidence interval of the pooled odds ratio. Gastroenterology 2010 139, 1246-1256.e5DOI: (10.1053/j.gastro.2010.06.019) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Clinical course and stages of cirrhosis, and a proposal for a fifth stage. A previously published staging system5 proposed stages 1 and 2 as compensated cirrhosis: stage 1, without esophagogastric varices or ascites (1-year mortality, <1%); stage 2, with varices but without ascites (1-year mortality, ∼3%–4%). Decompensated cirrhosis comprised stage 3 with ascites ± varices (1-year mortality, ∼20%), and stage 4 with bleeding ± ascites (1-year mortality, 50%, which is now becoming less). Sepsis that develops mostly in decompensated patients (1-year mortality, >60%), reflecting more advanced cirrhosis, is proposed as stage 5. Gastroenterology 2010 139, 1246-1256.e5DOI: (10.1053/j.gastro.2010.06.019) Copyright © 2010 AGA Institute Terms and Conditions