The prognostic significance of bacterial DNA in patients with decompensated cirrhosis and suspected infection
| Autor: | Johannes H. Schade, Sven Stengel, Beate Appenrodt, Frank Lammert, Tony Bruns, Andreas Stallmach, Stefan Zeuzem, Ludmila Gerber, Philipp A. Reuken |
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| Rok vydání: | 2015 |
| Předmět: |
0301 basic medicine
DNA Bacterial Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Peritonitis Drug resistance Chronic liver disease Gastroenterology Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Spontaneous bacterial peritonitis Internal medicine Drug Resistance Multiple Bacterial Germany Ascites medicine Ascitic Fluid Humans Prospective Studies Prospective cohort study Survival analysis Aged Hepatology business.industry Acute-On-Chronic Liver Failure Middle Aged medicine.disease Prognosis Survival Analysis 030104 developmental biology Bacterial Translocation Multivariate Analysis 030211 gastroenterology & hepatology Female medicine.symptom business Biomarkers |
| Zdroj: | Liver international : official journal of the International Association for the Study of the Liver. 36(8) |
| ISSN: | 1478-3231 |
| Popis: | Background & aims Circulating and peritoneal fragments of microbial DNA (bactDNA) 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 bactDNA 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 BactDNA in either compartment was detected in 134 (61%) patients, comprising 54 with bactDNA in blood and AF, 48 with AF bactDNA only, and 32 with blood bactDNA only. BactDNA 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 bactDNA 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 bactDNA in both compartments and did not differ if bactDNA 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 BactDNA 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. |
| Databáze: | OpenAIRE |
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