Bacterascites is associated with poor clinical outcome in decompensated cirrhosis.
AASLD LiverLearning®. Oey R. Nov 14, 2016; 144977
Topic: Ascites and Other Complications
Label: Portal Hypertension: Ascites, Renal Dysfunction, and Hepatorenal Syndrome
Ms. Rosalie Oey
Ms. Rosalie Oey
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TITLE: Bacterascites is associated with poor clinical outcome in decompensated cirrhosis.

This study was sponsored by the Foundation for Liver and Gastrointestinal Research (SLO).

Background: Bacterascites is a common variant of ascitic fluid infection. Limited information is available regarding this entity and the prognostic impact. Therefore, we aimed to evaluate the prognostic significance of bacterascites.

Methods: Retrospective study of all consecutive ascitic cultures obtained between in 2003 to 2006 and 2013 to 2015 in patients with decompensated liver cirrhosis. Patient records were used to evaluate demographic, clinical, and laboratory data. Patients were classified in three groups: bacterascites, SBP, and non-neutrocytic sterile cultures (control). SBP was defined as a polymorphonuclear neutrophil count ≥250 cells/µL in ascites and bacterascites as bacterial presence in ascites with a polymorphonuclear neutrophil count <250 cells/µL. Patients with bacterascites developing SBP within 7 days were classified as SBP and after 7 days excluded. The clinical outcome survival was defined as no liver transplantation or death one year after ascites diagnosis.

Results: A total of 304 patients were included (62% male, mean age 56 (SD±12) years, mean MELD 19 (SD±8)). Thirty-one patients were diagnosed with bacterascites, 85 with SBP and 188 patients were considered as controls. SBP patients were younger with a mean age of 54 years (P=0.041), and control patients had a lower MELD score 18 (P=0.006). Uni- and multivariate proportional-hazard analysis identified MELD score (HR 1.066; CI 1.048-1.084; P<0.001), albumin <11 g/L in ascites (HR 1.714; CI 1.074-2.736; P=0.024), bacterascites (HR 1.990; CI 1.226-3.232; P=0.005), and SBP (HR 1.486; CI 1.040-2.122; P=0.029) as risk factors, increasing the probability of liver transplantation or death within 1 year. There was no statistically significant difference between SBP and bacterascites regarding the bacterial flora. Survival analysis indicated that the prognosis of bacterascites and SBP patients was comparable and significantly worse than in the control group (P=0.005).

Conclusions: Bacterascites is an independent prognostic factor for survival in patients with decompensated cirrhosis. Currently, the important impact of bacterascites might be underestimated. Presumably, mechanisms involved in bacterial translocation and neutrophil immune response determine the poor prognosis associated with bacterascites.

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