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Bacterial DNA is a prognostic factor for mortality in patients who recover from spontaneous bacterial peritonitis

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Bacterial DNA is a prognostic factor for mortality in patients who recover from spontaneous bacterial peritonitis (EN)
Dourakis, Spyros P.
Alexopoulos, Theodoros
Mani, Iliana
Tsiamis, Constantinos
Alexopoulou, Alexandra
Hadziyannis, Emilia
Tsiriga, Athanasia
Vasilieva, Larisa
Vrioni, Georgia
Tsakris, Athanasios
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
2021-11-20
Background Spontaneous bacterial peritonitis (SBP) is associated with a high mortality. The aim was to investigate whether bacterial deoxyribonucleic acid (bactDNA) could offer an accurate identification of pathogens and to explore its prognostic role during and early after an SBP episode. Methods Consecutive patients with SBP (SBP-group) and patients with decompensated cirrhosis without SBP/bacterascites (control-group) were enrolled. Standard culture methodology was used to isolate and identify pathogens from blood and ascitic fluid (AF). The SeptiFast test was used to identify bactDNA directly from AF. Results Fifty-five patients, median age 60 (interquartile range [IQR] 53-74), model-for-end-stage liver disease (MELD) score 18 (IQR 13-29), with SBP were prospectively included. AF cultures were positive in 52.7% (17.2% drug-resistant bacteria) and bactDNA in 29.1% (58.2% combined sensitivity). BactDNA results were 84.6% concordant with AF cultures. Three patients had positive bactDNA in the culture-negative SBP-group. BactDNA was negative in all 36 of the control group (100% specificity). In multivariate analysis for 7-day survival, factors adversely affecting outcome were MELD (P=0.049) and C-reactive protein (P=0.012). After patients who died during the first week post-admission were excluded, patients with positive bactDNA had a poor prognosis compared to those with a negative test (log-rank P=0.005). Variables independently associated with 30-day mortality were neutrophil-to-lymphocyte ratio (P=0.011) and positive bactDNA (P=0.020). Conclusions No evidence was found for the usefulness of bactDNA to improve bacterial identification during an SBP episode. However, bactDNA was a predictor of 30-day mortality in the subset of patients who recovered from the infection episode. Keywords Spontaneous bacterial peritonitis, culture-positive SBP, neutrophil-to-lymphocyte ratio, bacterial DNA, survival Ann Gastroenterol 2021; 34 (6): 852-861 (EN)
English
Hellenic Society of Gastroenterology (EN)
1792-7463
1108-7471
Annals of Gastroenterology; Volume 34, No 6 (2021); 852 (EN)
Copyright (c) 2021 Annals of Gastroenterology (EN)
Hellenic Society of Gastroenterology
Annals of Gastroenterology
Original Articles



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