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

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 nonselective 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 signifcantly higher mortality compared to those with positive cultures. Early mortality and short-term mortality are mainly infuenced by the underlying severity of liver disease. In this contest, therapy with NSBBs has a positive impact on short-term surviva