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- Title
The prognostic significance of bacterial DNA in patients with decompensated cirrhosis and suspected infection.
- Authors
Bruns, Tony; Reuken, Philipp A.; Stengel, Sven; Gerber, Ludmila; Appenrodt, Beate; Schade, Johannes H.; Lammert, Frank; Zeuzem, Stefan; Stallmach, Andreas
- Abstract
Background & Aims Circulating and peritoneal fragments of microbial DNA (bact DNA) are evidence for bacterial translocation in decompensated cirrhosis and may serve as a rational approach for antibiotic therapy when infection is suspected. Methods Prospective multicenter study to investigate whether identification of bact DNA from blood or ascitic fluid ( AF) by multiplex polymerase chain reaction ( PCR) is associated with increased 90-day mortality in 218 patients with cirrhosis and signs of infection. Results Bact DNA in either compartment was detected in 134 (61%) patients, comprising 54 with bact DNA in blood and AF, 48 with AF bact DNA only, and 32 with blood bact DNA only. Bact DNA was associated with spontaneous bacterial peritonitis and blood stream infections ( SBP/ BSI), acute-on-chronic liver failure ( ACLF), encephalopathy and markers of inflammation. The prevalence of bact DNA in patients with proven SBP/ BSI (36/49; 73%) was similar to that in patients with sterile ACLF (37/52; 71%). Actuarial 90-day survival was 56 ± 5% in the absence of bact DNA in both compartments and did not differ if bact DNA was detected in blood only (63 ± 9%), AF only (63 ± 7%), or in blood and AF (52 ± 7%). Predictors of 90-day mortality were SBP ( HR = 3.10; 95% CI: 1.90-5.06), BSI ( HR = 4.94; 95% CI: 2.71-9.02), and ACLF ( HR = 2.20; 95% CI: 1.44-3.35). The detection of resistance genes in blood or AF in the absence of SBP/ BSI ( n = 11) was associated with poor 1-year survival ( HR = 2.35; 95% CI: 1.03-5.35). Conclusions Bact DNA in sterile body fluids did not indicate increased mortality in cirrhotic patients with suspected infection. Using multiplex PCR for risk stratification cannot be recommended in these patients.
- Subjects
BACTERIAL DNA; CIRRHOSIS of the liver; ANTIBIOTICS; POLYMERASE chain reaction; MICROBIAL genetics; PATIENTS
- Publication
Liver International, 2016, Vol 36, Issue 8, p1133
- ISSN
1478-3223
- Publication type
Article
- DOI
10.1111/liv.13095