Variants of Ascitic Fluid Bacterial Infections and Clinical Outcomes in Patients with Liver Cirrhosis

Abstract

Background: Ascitic fluid infection (AFI) is the most common bacterial infection in patients with cirrhosis and has several variants, including spontaneous bacterial peritonitis (SBP), bacterascites (BA), and culture-negative neutrocytic ascites (CNNA). Objectives: To date, there has been disagreement about the differences in clinical features and outcomes of these variants of AFI, and there are still few studies in this area. Methods: A cross-sectional study was conducted at a referral hospital from June 2018 to September 2022. All cirrhotic patients with ascites were evaluated for the presence of AFI. Patients with AFI were divided into SBP, BA, and CNNA variants. Non-AFI participants were also evaluated as a comparison group. The outcomes, as well as the clinical and laboratory characteristics of the variants of AFI, were compared. Kaplan-Meier curves and Cox regression analysis were used for survival analysis. Results: A total of 466 patients were studied, of which 132 (28.33%) were in the AFI group and 334 (71.67%) were in the non-AFI group. In the AFI group, 64 (48.48%) had SBP, 43 (32.58%) had CNNA, and 25 (18.94%) had BA. The most common bacteria causing AFI was Escherichia coli. SBP (HR 2.43; 95% CI 1.36 - 4.36; P = 0.003) significantly increased the risk of mortality, while CNNA and BA did not significantly increase this risk. The presence of hepatic encephalopathy and female gender also significantly increased the risk of mortality. Conclusions: The mortality risk was higher in patients with SBP compared to other types of AFI. This study also showed differences in clinical characteristics and laboratory parameters among the three types of AFI. Further research is recommended.