title: Serum and ascitic fluid bacterial DNA: a new independent prognostic factor in noninfected patients with cirrhosis.
abstract: 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)/muL, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unidad Hepática, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Rubén
authors.initials: R
authors.lastname: Francés
authors.forename: José M
authors.initials: JM
authors.lastname: González-Navajas
authors.forename: Maria A
authors.initials: MA
authors.lastname: de la Hoz
authors.forename: Rocío
authors.initials: R
authors.lastname: Moreu
authors.forename: Sonia
authors.initials: S
authors.lastname: Pascual
authors.forename: David
authors.initials: D
authors.lastname: Monfort
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoliu
authors.forename: Carmen
authors.initials: C
authors.lastname: Vila
authors.forename: Amparo
authors.initials: A
authors.lastname: Escudero
authors.forename: Xavier
authors.initials: X
authors.lastname: Torras
authors.forename: Isabel
authors.initials: I
authors.lastname: Cirera
authors.forename: Lucía
authors.initials: L
authors.lastname: Llanos
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: José M
authors.initials: JM
authors.lastname: Palazón
authors.forename: Fernando
authors.initials: F
authors.lastname: Carnicer
authors.forename: Pablo
authors.initials: P
authors.lastname: Bellot
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner
authors.forename: Ramón
authors.initials: R
authors.lastname: Planas
authors.forename: Ricard
authors.initials: R
authors.lastname: Solá
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Serra
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Mateo
authors.forename: José
authors.initials: J
authors.lastname: Such
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000453:epidemiology / Q000382:microbiology; D001202:Ascitic Fluid / Q000382:microbiology*; D004269:DNA, Bacterial / Q000097:blood*; D004926:Escherichia coli / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000378:metabolism / Q000382:microbiology* / Q000401:mortality; D017093:Liver Failure / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000382:microbiology; D010538:Peritonitis / Q000453:epidemiology / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D004269:DNA, Bacterial