Τίτλος:
Bacterial DNA is a prognostic factor for mortality in patients who
recover from spontaneous bacterial peritonitis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Mani, Iliana
Vrioni, Georgia
Hadziyannis, Emilia and
Alexopoulos, Theodoros
Vasilieva, Larisa
Tsiriga, Athanasia and
Tsiamis, Constantinos
Tsakris, Athanasios
Dourakis, Spyros P.
and Alexopoulou, Alexandra
Περιοδικό:
ANNALS OF GASTROENTEROLOGY
Εκδότης:
HELLENIC SOC GASTROENTEROLOGY
Λέξεις-κλειδιά:
Spontaneous bacterial peritonitis; culture-positive SBP;
neutrophil-to-lymphocyte ratio; bacterial DNA; survival
DOI:
10.20524/aog.2021.0665
