Dissertation committee:
Σπυρίδων Ντουράκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Παπαθεοδωρίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σπήλιος Μανωλακόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάνδρα Αλεξοπούλου, Αναπληρώτρια Καθηγήτρια, Ιατρική ΣΧολή, ΕΚΠΑ
Αιμιλία Χατζηγιάννη, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βλαχογιαννάκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Χολόγγιτας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Translated title:
Αssessment of the clinical importance of the identification of bacterial DNA in blood or ascites in hospitalized patients with cirrhosis and a high suspicion of infection, by using real time polymerase chain reaction
Summary:
Background: Spontaneous bacterial peritonitis (SBP) is associated with high mortality-rate. The aim was to investigate if bacterial deoxyribonucleic-acid (bactDNA) could offer an accurate identification of pathogens and 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 for isolation and identification of pathogens from blood and ascitic-fluid (AF). SeptiFast test (Roche-Diagnostics) was used to identify bactDNA directly from AF. Mortality was studied in the SBP-group.
Results: Fifty-five patients [median age 60 (IQR 53-74), 69.1% male, MELD score 18 (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 culture-negative SBP-group. BactDNA was negative in all 36 of the control-group (100% specificity). No resistance-study was available by the bactDNA method. In Cox multivariate regression analysis for 7-day survival, factors adversely affecting outcome were MELD (P=0.049) and C-reactive-protein (P=0.012). After excluding cases that died during the first week post-admission, patients with positive bactDNA had a poor prognosis compared to those with negative (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).
Conclusion: No evidence was provided for the usefulness of bactDNA in order to improve bacterial identification during SBP-episode. However, bactDNA was a predictor of 30-day mortality in the subset of patients who recovered from the infection episode.
Keywords:
Cirrhosis, Spontaneous bacterial peritonitis, Bacterial DNA, Polymerase chain reaction, Mortality
