Detection of molecular bacterascites in decompensated cirrhosis defines a risk with decreased survival

Engelmann, Cornelius; Krohn, Sandra; Prywerek, D; Hartmann, Jan; Herber, Adam; Boehlig, Albrecht; Zeller, K; Boehm, Stephan; Berg, Thomas

doi:10.1097/meg.0000000000000712

Cited by 12 publications

(12 citation statements)

References 38 publications

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“…Such discrepancies highlight that the relationship of presence or amount of bacterial DNA is not a strong predictor for decompensation and systemic inflammation in these patients, and probably also does not explain compartmentalization of the immune response. However, recent studies show an association of bacterial DNA levels in ascites and survival (32,33). Therefore, we have characterized the microbiome of matched ascites and blood samples from patients with decompensated liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Compartmentalization of immune response and microbial translocation in decompensated cirrhosis

Alvarez-Silva

Schierwagen

Pohlmann

et al. 2019

35. Jahrestagung Der Deutschen Arbeitsgemeinschaft Zum Studium Der Leber

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Section: Discussionmentioning

confidence: 99%

Compartmentalization of immune response and microbial translocation in decompensated cirrhosis

Alvarez-Silva

Schierwagen

Pohlmann

et al. 2019

35. Jahrestagung Der Deutschen Arbeitsgemeinschaft Zum Studium Der Leber

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“…The major points of criticisms are that due to a multitude of different PCR techniques results are difficult to compare. Using ultraclean reagents to avoid positive signals from contaminations can significantly boost its quality [53] and its significance as an additional diagnostic technique. This method quickly provides information about the presence or absence of pathogens and identifies pathogens down to species levels [53,54].…”

Section: Diagnosticsmentioning

confidence: 99%

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Engelmann

Berg

2018

Visc Med

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Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: ‘acute-on-chronic liver failure', ‘infection', ‘ACLF', ‘bacteria', ‘multi-resistance'. Results: Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion: The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.

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“…Engelmann et al [ 69 ] suggested the new term “molecular bacterascites” and quantified bactDNA in ascitic fluid samples using a culture-independent 16S rRNA gene-based method. They demonstrated that patients’ survival was positively associated with bactDNA levels.…”

Section: Bt Markersmentioning

confidence: 99%

“…All the five aforementioned studies [ 66 - 69 ] demonstrated that the clinical and diagnostic relevance of bactDNA in patients with liver cirrhosis has not been well documented [ 70 ]. In all the above studies, bactDNA was determined by PCR for the universal amplification of a region of the 16S ribosomal RNA ( 16SrRNA ) gene followed by nucleotide sequencing.…”

Section: Bt Markersmentioning

confidence: 99%

“…In all the above studies, bactDNA was determined by PCR for the universal amplification of a region of the 16S ribosomal RNA ( 16SrRNA ) gene followed by nucleotide sequencing. In a number of studies, a qualitative PCR was used to detect the presence or absence of bactDNA [ 25 , 26 , 30 , 62 , 64 , 66 ], while in others a quantification of bactDNA was performed [ 29 , 63 , 67 , 69 ]. Recently, more standardized methods, such as multiplex PCR, and different patient cohorts have been used.…”

Section: Bt Markersmentioning

confidence: 99%

See 1 more Smart Citation

Bacterial translocation markers in liver cirrhosis

Alexopoulou¹

2017

aog

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Bacterial translocation (BT) is an important mechanism in the development of infection in liver cirrhosis. The migration and colonization of bacteria and/or bacterial products from the bowel to mesenteric lymph nodes is a controlled process in healthy persons. Increased intestinal permeability, bacterial overgrowth and defect of gut-associated lymphatic tissue promote impaired BT in cirrhotics. We reviewed the reports on markers used for the evaluation of BT published between 1987 and 2016. We focused on the clinical consequences of BT in cirrhosis, as indicated by the values of the BT markers. Patients with cirrhosis are reported to have elevated levels of surrogate markers associated with BT compared with controls. The most widely used BT parameters are C-reactive protein, procalcitonin, bacterial DNA, endotoxin or lipopolysaccharide, lipopolysaccharide binding protein, calprotectin, and bactericidal/permeability increasing protein. High levels of these factors in serum and/or ascitic fluid in humans may be associated with advanced liver disease, hemodynamic instability, high levels of proinflammatory cytokines, susceptibility to the development of severe or recurrent infections, acute-on-chronic liver failure, hepatic encephalopathy, hepatorenal syndrome and poor prognosis during follow up. In conclusion, high levels of BT markers are associated with a high inflammatory response, increased complications of liver cirrhosis and occasionally high fatality rates.

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Detection of molecular bacterascites in decompensated cirrhosis defines a risk with decreased survival

Cited by 12 publications

References 38 publications

Compartmentalization of immune response and microbial translocation in decompensated cirrhosis

Compartmentalization of immune response and microbial translocation in decompensated cirrhosis

Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure

Bacterial translocation markers in liver cirrhosis

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