Bacterascites confers poor patient prognosis beyond MELD prediction

Abstract

Spontaneous bacterial peritonitis (SBP) is a well-recognized clinical entity with a poor prognosis. In comparison, the prevalence, microbiological flora, and prognostic significance of bacterascites (BA) (the presence of organism on culture but ascitic PMN <250 cells/mm³) is largely unknown. We, therefore, assessed the prognosis and predictors of outcome in patients with BA in comparison with those with SBP. Ascitic fluid cultures from consecutive patients with cirrhosis from 2008 to 2018 were reviewed retrospectively, and patients with SBP and BA were identified. Baseline demographic, laboratory, and microbiological data were collated and analyzed as prognostic indicators, and clinical outcomes were recorded. Patients were censored at the time of LT, death, or last follow-up. For this study 176 and 213 cases of SBP and BA, respectively, were identified and included. Patients with SBP had significantly higher Model for End-Stage Liver Disease (MELD) (p=<0.01), peripheral blood WCC (p < 0.01), and higher rates of Enterobacteriaceae (p < 0.01) and multi-drug resistant pathogens (p < 0.01). Survival at 1 and 3 months was lower in patients with SBP (p < 0.01) when compared with BA but at 6 months and beyond, no significant difference remained. After the exclusion of deaths within 30 days of presentation, survival between SBP and BA was equivocal at all time points. Mortality was substantially higher across all MELD groupings for both SBP and BA when compared with the predicted mortality calculated by the MELD score alone. BA has a negative impact on patient survival above that predicted by the MELD score. It has similar impact to SBP on patient survival beyond 1 month suggesting it should be seen as a poor prognostic marker and prompt consideration of LT where appropriate. Further studies evaluating the role of secondary prophylaxis in this group are required.

Antibiotic treatment in cirrhotic patients

“…King et al [ 9 ] evaluated retrospectively 176 cases of SBP and 213 cases of BA from 2008 to 2018. The authors found that the SBP patients had significantly higher Model for End-Stage Liver Disease (MELD) scores, peripheral blood white cell counts, and rates of Enterobacteriaceae and MDR.…”

“…Patients with SBP had a lower survival rate at 30 d and 3 mo compared to BA, but no significant difference remained at 6 mo and beyond. The predicted mortality calculated by the MELD score alone was significantly lower than the mortality across all MELD groups for both SBP and BA; BA had a greater negative impact on patient survival than what was predicted by the MELD score[ 9 ]. The mortality rates are certainly not unequivocal in cirrhotic patients, and mortality does not depend on infection alone but in primis on liver and kidney function and the timeliness of medical treatment.…”

Kommentar zu: Positive Effekte von Probiotika bei Leberzirrhose nachgewiesen

“…Es wäre interessant zu erfahren, ob zwischen beiden Gruppen ein Unterschied hinsichtlich der Inzidenz von bakteriellen Infektionen bestand, da Probiotika in einigen Studien die Rate an Infektionen senken konnten 1 . Infektionen wie die spontan bakterielle Peritonitis führen wiederum zu einer Verschlechterung der Leberfunktion und der Prognose der Patienten vor Lebertransplantation 2 . Schade ist weiterhin, dass die Autoren Patienten mit cholestatischen Erkrankungen ausgeschlossen haben, weil gerade diese Gruppe häufig Infektionen entwickelt.…”

The Incidence of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis-Related Ascites Undergoing Elective Outpatient Large-Volume Paracentesis

“…6 /L. These outcomes were chosen due to their direct association with poor prognosis and high mortality[7,11].2023 Arzivian et al Cureus 15(12): e50191. DOI 10.7759/cureus.50191…”