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Background & Aims Human neutrophil peptides (HNP)‐1, ‐2 and ‐3 are the most abundant proteins in neutrophil azurophilic granules and are rapidly released via neutrophil degranulation upon activation. The aims of our study were to assess the role of HNP1‐3 as biomarkers of disease severity in patients with decompensated cirrhosis and their value in predicting short‐term mortality. Methods In this study, 451 patients with acutely decompensated cirrhosis (AD) were enrolled at the two medical centres. Overall, 281 patients were enrolled as the training cohort from October 2015 to April 2019, and 170 patients were enrolled as the validation cohort from June 2020 to February 2021. Plasma HNP1‐3 levels were measured using enzyme‐linked immunosorbent assay (ELISA). Results Plasma HNP1‐3 increased stepwise with disease severity (compensated cirrhosis: 0.3 (0.2–0.4); AD without acute‐on‐chronic liver failure (ACLF): 1.9 (1.3–4.8); ACLF‐1: 2.3 (1.8–6.1); ACLF‐2: 5.6 (2.9–12.3); ACLF‐3: 10.3 (5.7–17.2) ng/ml). From the multivariate Cox regression analysis, HNP1‐3 emerged as independent predictors of mortality at 30 and 90 days. Similar results were observed in the subgroup analysis. On ROC analysis, plasma HNP1‐3 showed better predictive accuracy for 30‐ and 90‐day mortality (area under the receiver operating characteristic (AUROC) of 0.850 and 0.885, respectively) than the neutrophil‐to‐lymphocyte ratio (NLR) and similar accuracy as end‐stage liver disease (MELD: 0.881 and 0.874) and chronic liver failure‐sequential organ failure (CLIF‐SOFA: 0.887 and 0.878). Conclusions Plasma HNP1‐3 levels were closely associated with disease severity and might be used to identify patients with AD at high risk of short‐term mortality.

BACKGROUNDSpontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites. Spontaneous fungal peritonitis (SFP) is a type of spontaneous peritonitis that is a less recognized but devastating complication in end-stage cirrhosis. Although high mortality was previously noted, scant data are available to fully define the factors responsible for the occurrence of SFP and its mortality.AIMTo illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for the occurrence of SFP and its short-term mortality.METHODSWe performed a matched case-control study between January 1, 2007 and December 30, 2018. Patients with SFP were included in a case group. Sex-, age-, and time-matched patients with SBP were included in a control group and were further divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture). The clinical features and laboratory parameters, severity models, and prognosis were compared between the case and control groups. Logistic regression analysis was used to determine the risk factors for occurrence, and the Cox regression model was used to identify the predictive factors for short-term mortality of SFP.RESULTSPatients with SFP exhibited more severe systemic inflammation, higher ascites albumin and polymorphonuclear neutrophils, and a worsened 15-d mortality than patients in the control groups. Antibiotic administration (case vs control-1: OR = 1.063, 95%CI: 1.012-1.115, P = 0.014; case vs control-2: OR = 1.054, 95%CI: 1.014-1.095, P = 0.008) remarkably increased the occurrence of SFP or fungiascites. Hepatorenal syndrome (HR = 5.328, 95%CI: 1.050-18.900) and total bilirubin (μmol/L; HR = 1.005, 95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.CONCLUSIONLong-term antibiotic administration increases the incidence of SFP, and hepatorenal syndrome and total bilirubin are closely related to short-term mortality.

Background and Objective Polymicrobial bloodstream infections (PBSI) in hospitalized patients are associated with increased mortality, while few studies have characterized the clinical features in this population. This study aimed to assess the risk factors and short-term prognosis of PBSI in hospitalized patients.Materials and Methods 4066 patients with culture-positive blood were included between January 1, 2015 and December 31, 2017 in the First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China) in our study. 218 patients were diagnosed as PBSI. The patients were divided into two groups according to the outcome after 30-day follow-up. The number of survival group were 129, while the number of non-survival group were 89. The clinical data, identified microorganisms and severity models were compared between the two groups. A cox regression model was used to identify the risk factors of 30-day mortality in PBSI patients. Five prediction models were compared by Z-test to test the value of these models to predict outcome of PBSI.Results The patients in the non-survival group were more likely to receive inappropriate antibiotic therapy at the time of PBSI and showed more severe in systemic inflammatory. They were more likely to develop to be septic shock and to be admitted in ICU than the patients in the survival group. Inappropriate initial empirical antimicrobial therapy (HR=1.713 95% CI: 1.063-2.760, p=0.027), white blood cell (HR=1.740 95% CI: 1.002-3.020, p=0.049) and platelet (HR=2.940 95% CI: 1.754-4.930, p<0.001) were independent risk factors for 30-day mortality in PBSI patients. SOFA (AUROC=0.882, 95% CI=0.832-0.922) scores was a good prognostic scoring system for predicting short-term mortality in PBSI patients. The SOFA score was more valuable than the other four models in predicting the outcome of PBSI according to the Z-test (p<0.05).Discussion and Conclusions Inappropriate initial empirical antimicrobial therapy, white blood cell and platelet were closely associated with short-term mortality.