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Serum and ascitic fluid bacterial DNA: A new independent prognostic factor in noninfected patients with cirrhosis
Author(s) -
Zapater Pedro,
Francés Rubén,
GonzálezNavajas José M.,
de la Hoz Maria A.,
Moreu Rocío,
Pascual Sonia,
Monfort David,
Montoliu Silvia,
Vila Carmen,
Escudero Amparo,
Torras Xavier,
Cirera Isabel,
Llanos Lucía,
GuarnerArgente Carlos,
Palazón José M.,
Carnicer Fernando,
Bellot Pablo,
Guarner Carlos,
Planas Ramón,
Solá Ricard,
Serra Miguel A.,
Muñoz Carlos,
PérezMateo Miguel,
Such José
Publication year - 2008
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.22564
Subject(s) - spontaneous bacterial peritonitis , ascites , cirrhosis , medicine , gastroenterology , ascitic fluid , paracentesis , peritonitis , liver disease
We tested the hypothesis that the presence of bacterial DNA (bactDNA) in ascitic fluid and serum is associated with decreased survival in patients with cirrhosis. In a prospective, multicenter study, we analyzed the clinical evolution of 156 patients with cirrhosis and ascites (first or recurrence) with lower than 250 polymorphonuclear cells (PMN)/μL, negative ascites bacteriological culture, and absence of other bacterial infections being admitted for evaluation of large‐volume paracentesis, according to the presence of bactDNA at admission. Survival, causes of death, and successive hospital admissions were determined during a 12‐month follow‐up period. BactDNA was detected in 48 patients. The most prevalent identified bactDNA corresponded to Escherichia coli (n = 32/48 patients, 66.6%). Patients were followed for 12 months after inclusion and in this period 34 patients died: 16 of 108 (15%) bactDNA negative versus 18 of 48 (38%) bactDNA positive ( P = 0.003). The most frequent cause of death was acute‐on‐chronic liver failure in both groups (7/16 and 9/18 in patients without or with bactDNA, respectively), although more prevalent in the first month of follow‐up in patients with presence of bactDNA (0 versus 4/7). When considering patients with model for end‐stage liver disease (MELD) score less than 15, mortality was significantly higher in those with presence of bactDNA. Spontaneous bacterial peritonitis developed similarly in patients with or without bactDNA at admission. Conclusion : The presence of bactDNA in a patient with cirrhosis during an ascitic episode is an indicator of poor prognosis. This fact may be related to the development of acute‐on‐chronic liver failure at short term and does not predict the development of spontaneous bacterial peritonitis. (H EPATOLOGY 2008;48:1924‐1931.)