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. 2022 Jun;67(6):2655-2665.
doi: 10.1007/s10620-021-07047-6. Epub 2021 May 26.

Cirrhotic Patients with Bacterial Infection and Negative Cultures Have a More Advanced Disease and an Increased Short-Term Mortality Rate

Gaia Caccamo  1   2 , Maria Stella Franzè  3   4   5 , Francesca Saffioti  6 , Concetta Pitrone  3   4   5 , Serena Porcari  4   7 , Angela Alibrandi  8 , Roberto Filomia  3   4 , Placido Mondello  4   9 , Irene Cacciola  3   4   5 , Carlo Saitta  3   4 , Giovanni Squadrito  4   5   10 , Giovanni Raimondo  3   4   5 , Sergio Maimone  3   4
Affiliations

Cirrhotic Patients with Bacterial Infection and Negative Cultures Have a More Advanced Disease and an Increased Short-Term Mortality Rate

Gaia Caccamo et al. Dig Dis Sci. 2022 Jun.

Abstract

Background: The negative clinical impact of bacterial infections (BI) in patients with cirrhosis is well documented. In cirrhotic patients, failure to isolate the pathogen is a frequent event, occurring in 30-40% of cases.

Aim: The aim of this study was to compare the clinical characteristics, early (30-day) and short-term (90-day) mortality rates, in a cohort of cirrhotic patients with BI, between those with positive (C-pos) and those with negative (C-neg) microbiological cultures.

Methods: We retrospectively enrolled 279 consecutive hospitalized cirrhotic patients with BI. Survival and predictors of 30-day and 90-day mortality were assessed by Kaplan-Meier curves and logistic regression analysis, respectively.

Results: Cultures tested negative in 108/279 (38.7%) patients. C-neg patients were more frequently males (p = 0.035), had higher Child-Pugh-Turcotte (CPT; p = 0.007) and model for end-stage liver disease-sodium (MELD-Na; p = 0.043) scores, and had more frequently decompensated liver disease (p = 0.04). Mortality rate was higher in C-neg than in C-pos patients, both at 30 days (22.2% versus 11.7%, p = 0.024) and 90 days (46.3% versus 33.3%, p = 0.030). MELD-Na score and non-selective beta-blockers (NSBBs) were independent risk factors for 30-day and 90-day mortality. In particular, the use of NSBBs was independently associated with a lower 30-day and 90-day mortality risk (OR 0.41, CI95% 0.17-0.94, p = 0.040; and OR 0.43, CI95% 0.25-0.75, p = 0.003, respectively).

Conclusions: Cirrhotic patients with BI and negative microbiological cultures have significantly higher mortality compared to those with positive cultures. Early mortality and short-term mortality are mainly influenced by the underlying severity of liver disease. In this contest, therapy with NSBBs has a positive impact on short-term survival.

Keywords: Bacterial infection; Liver cirrhosis; Mortality risk factors; Negative microbiological culture.

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