Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China.
Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing Institute of Hepatology, Beijing You'An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China.
Hepatol Int. 2024 Aug;18(4):1249-1260. doi: 10.1007/s12072-024-10669-3. Epub 2024 Apr 29.
Droplet digital PCR (ddPCR) is increasingly used in diagnosing clinical pathogens, but its effectiveness in cirrhosis patients with suspected ascites infection remains uncertain.
The diagnostic performance of ddPCR was assessed in 305 ascites samples, utilizing culture and clinical composite standards. The quantitative value and potential clinical impact of ddPCR were further analyzed in patients with spontaneous bacterial peritonitis.
With culture standards, ddPCR demonstrated a sensitivity of 86.5% and specificity of 83.2% for bacterial or fungal detection. After adjustment of clinical composite criteria, specificity increased to 96.4%. Better diagnostic performance for all types of targeted pathogens, particularly fungi, was observed with ddPCR compared to culture, and more polymicrobial infections were detected (30.4% versus 5.7%, p < 0.001). Pathogen loads detected by ddPCR correlated with white blood cell count in ascites and blood, as well as polymorphonuclear cell (PMN) count in ascites, reflecting infection status rapidly. A positive clinical impact of 55.8% (43/77) was observed for ddPCR, which was more significant among patients with PMN count ≤ 250/mm in terms of medication adjustment and new diagnosis. ddPCR results for fungal detection were confirmed by clinical symptoms and other microbiological tests, which could guide antifungal therapy and reduce the risk of short-term mortality.
ddPCR, with appropriate panel design, has advantages in pathogen detection and clinical management of ascites infection, especially for patients with fungal and polymicrobial infections. Patients with atypical spontaneous bacterial peritonitis benefited more from ddPCR.
液滴数字 PCR（ddPCR）在诊断临床病原体方面的应用日益广泛，但在疑似腹水感染的肝硬化患者中的效果尚不确定。
利用培养和临床综合标准评估了 ddPCR 在 305 例腹水样本中的诊断性能。进一步分析了自发性细菌性腹膜炎患者中 ddPCR 的定量值和潜在临床影响。
以培养标准为依据，ddPCR 对细菌或真菌检测的敏感性为 86.5%，特异性为 83.2%。在调整临床综合标准后，特异性提高至 96.4%。ddPCR 对所有类型的靶向病原体的诊断性能均优于培养，特别是真菌，且检测到更多的混合感染（30.4%比 5.7%，p<0.001）。ddPCR 检测到的病原体负荷与腹水和血液中的白细胞计数以及腹水中性粒细胞计数相关，迅速反映了感染状态。ddPCR 具有 55.8%（43/77）的阳性临床影响，在中性粒细胞计数≤250/mm 的患者中，在调整药物和新诊断方面的影响更为显著。ddPCR 对真菌检测的结果通过临床症状和其他微生物学检查得到证实，这可以指导抗真菌治疗并降低短期死亡率。
ddPCR 在设计合适的检测面板后，在腹水感染的病原体检测和临床管理方面具有优势，特别是对真菌和混合感染的患者。ddPCR 对不典型自发性细菌性腹膜炎患者更有益。
