Beiling Li1, Yanhang Gao2,3, Xianbo Wang4,3, Zhiping Qian5,3, Zhongji Meng6,3, Yan Huang7,3, Guohong Deng8,3, Xiaobo Lu9,3, Feng Liu10,3, Xin Zheng11,3, Hai Li12,3, Jinjun Chen1,3. 1. Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2. Department of Hepatology, The First Hospital of Jilin University (JU), Jilin, China. 3. Chinese (acute on) Chronic Liver Failure Consortium (Ch-CLIF.C), China. 4. Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China. 5. Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre (SPHCC), Fudan University, Shanghai, China. 6. Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Hubei, China. 7. Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Hunan, China. 8. Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China. 9. Infectious Disease Centre, The First Affiliated Hospital of Xinjiang Medical University (XMU), Xinjiang, China. 10. Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University (SDU), Jinan, China. 11. Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China. 12. Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Abstract
BACKGROUND & AIMS: Current guidelines on the management of bacterascites are limited. This multicentre, retrospective study investigated the clinical features and outcomes of cirrhosis patients with bacterascites. METHODS: Two series of cirrhosis patients were evaluated. The first included 418 patients with ascites-positive cultures at 11 hospitals during 2012-2018. Clinical characteristics and outcomes were recorded. The second included 208 patients with sterile ascites from a prospective cohort (NCT02457637). Clinical features and outcomes of cirrhotic patients with or without bacterascites were investigated. RESULTS: In the first series, bacterascites was diagnosed in 254/418 (60.8%) patients, and culture-positive spontaneous bacterial peritonitis (SBP) in 164/418 (39.2%) patients. Gram-positive bacteria were more prevalent in bacterascites patients than in culture-positive SBP patients (59.1% vs 22.0%; P < .001). For patients with acute-on-chronic liver failure (ACLF) in bacterascites and culture-positive SBP groups, the 28-day transplant-free mortality (41.3% vs 65.5%; P = .015) and the prevalence of in-hospital acute kidney injury (AKI) (84.8% vs 75%; P = .224). For patients without ACLF in the bacterascites (n = 208) and culture-positive SBP groups (n = 108), the 28-day transplant-free mortalities were 13% vs 13.9% (P = .822), the probabilities of progression to ACLF within 28 days were 10.1% vs 14.8% (P = .216) and the prevalences of in-hospital AKI were 14.4% vs 30.6% (P = .001). Bacterascites patients had higher 28-day mortality than those patients with sterile ascites, after propensity score matching (18.4% vs 8.6%; P = .010). CONCLUSION: Bacterascites patients had non-negligible poor clinical outcomes, including in-hospital AKI, progression to ACLF and 28-day mortality. Future studies are warranted to expedite the diagnosis of bacterascites and optimize antibiotic treatment.
BACKGROUND & AIMS: Current guidelines on the management of bacterascites are limited. This multicentre, retrospective study investigated the clinical features and outcomes of cirrhosispatients with bacterascites. METHODS: Two series of cirrhosispatients were evaluated. The first included 418 patients with ascites-positive cultures at 11 hospitals during 2012-2018. Clinical characteristics and outcomes were recorded. The second included 208 patients with sterile ascites from a prospective cohort (NCT02457637). Clinical features and outcomes of cirrhotic patients with or without bacterascites were investigated. RESULTS: In the first series, bacterascites was diagnosed in 254/418 (60.8%) patients, and culture-positive spontaneous bacterial peritonitis (SBP) in 164/418 (39.2%) patients. Gram-positive bacteria were more prevalent in bacterascites patients than in culture-positive SBP patients (59.1% vs 22.0%; P < .001). For patients with acute-on-chronic liver failure (ACLF) in bacterascites and culture-positive SBP groups, the 28-day transplant-free mortality (41.3% vs 65.5%; P = .015) and the prevalence of in-hospital acute kidney injury (AKI) (84.8% vs 75%; P = .224). For patients without ACLF in the bacterascites (n = 208) and culture-positive SBP groups (n = 108), the 28-day transplant-free mortalities were 13% vs 13.9% (P = .822), the probabilities of progression to ACLF within 28 days were 10.1% vs 14.8% (P = .216) and the prevalences of in-hospital AKI were 14.4% vs 30.6% (P = .001). Bacterascites patients had higher 28-day mortality than those patients with sterile ascites, after propensity score matching (18.4% vs 8.6%; P = .010). CONCLUSION: Bacterascites patients had non-negligible poor clinical outcomes, including in-hospital AKI, progression to ACLF and 28-day mortality. Future studies are warranted to expedite the diagnosis of bacterascites and optimize antibiotic treatment.
Authors: Lingyao Du; Yuanji Ma; Shaoqun Zhou; Fang Chen; Yan Xu; Ming Wang; Xuezhong Lei; Ping Feng; Hong Tang; Lang Bai Journal: Sci Rep Date: 2021-01-14 Impact factor: 4.379