Zapater Pedro, Francés Rubén, González-Navajas José M, de la Hoz Maria A, Moreu Rocío, Pascual Sonia, Monfort David, Montoliu Silvia, Vila Carmen, Escudero Amparo, Torras Xavier, Cirera Isabel, Llanos Lucía, Guarner-Argente Carlos, Palazón José M, Carnicer Fernando, Bellot Pablo, Guarner Carlos, Planas Ramón, Solá Ricard, Serra Miguel A, Muñoz Carlos, Pérez-Mateo Miguel, Such José
Unidad Hepática, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain.
Hepatology. 2008 Dec;48(6):1924-31. doi: 10.1002/hep.22564.
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.
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.
我们检验了这样一个假设，即腹水和血清中细菌DNA（bactDNA）的存在与肝硬化患者生存率降低有关。在一项前瞻性多中心研究中，我们根据入院时bactDNA的存在情况，分析了156例肝硬化腹水（初次或复发）患者的临床病程，这些患者多形核白细胞（PMN）低于250/μL，腹水细菌培养阴性，且无其他细菌感染，因需评估大量腹腔穿刺术而入院。在12个月的随访期内确定生存率、死亡原因和连续住院情况。48例患者检测到bactDNA。最常见的已鉴定bactDNA对应大肠杆菌（n = 32/48例患者，66.6%）。纳入患者后随访12个月，在此期间34例患者死亡：bactDNA阴性的108例中有16例（15%），bactDNA阳性的48例中有18例（38%）（P = 0.003）。两组中最常见的死亡原因均为慢加急性肝衰竭（bactDNA阴性和阳性患者分别为7/16和9/18），尽管在随访第一个月bactDNA阳性患者中更常见（0例对比4/7例）。当考虑终末期肝病模型（MELD）评分低于15的患者时，有bactDNA的患者死亡率显著更高。入院时有无bactDNA的患者自发性细菌性腹膜炎的发生情况相似。
肝硬化患者腹水发作期间bactDNA的存在是预后不良的指标。这一事实可能与短期内慢加急性肝衰竭的发生有关，且不能预测自发性细菌性腹膜炎的发生。
