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Clinical evaluation of droplet digital pcr for suspected ascites infection in patients with liver cirrhosis

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Abstract

Background

Droplet digital PCR (ddPCR) is increasingly used in diagnosing clinical pathogens, but its effectiveness in cirrhosis patients with suspected ascites infection remains uncertain.

Methods

The diagnostic performance of ddPCR was assessed in 305 ascites samples, utilizing culture and clinical composite standards. The quantitative value and potential clinical impact of ddPCR were further analyzed in patients with spontaneous bacterial peritonitis.

Results

With culture standards, ddPCR demonstrated a sensitivity of 86.5% and specificity of 83.2% for bacterial or fungal detection. After adjustment of clinical composite criteria, specificity increased to 96.4%. Better diagnostic performance for all types of targeted pathogens, particularly fungi, was observed with ddPCR compared to culture, and more polymicrobial infections were detected (30.4% versus 5.7%, p < 0.001). Pathogen loads detected by ddPCR correlated with white blood cell count in ascites and blood, as well as polymorphonuclear cell (PMN) count in ascites, reflecting infection status rapidly. A positive clinical impact of 55.8% (43/77) was observed for ddPCR, which was more significant among patients with PMN count ≤ 250/mm3 in terms of medication adjustment and new diagnosis. ddPCR results for fungal detection were confirmed by clinical symptoms and other microbiological tests, which could guide antifungal therapy and reduce the risk of short-term mortality.

Conclusions

ddPCR, with appropriate panel design, has advantages in pathogen detection and clinical management of ascites infection, especially for patients with fungal and polymicrobial infections. Patients with atypical spontaneous bacterial peritonitis benefited more from ddPCR.

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Data availability

The data presented in this study are available in article or supplementary material.

Abbreviations

CRP:

C-reactive protein

ddPCR:

Droplet digital PCR

mNGS:

Metagenomic next-generation sequencing

MN:

Mononuclear cell

NIA:

Noninfectious ascites

PMN:

Polymorphonuclear cell

PCT:

Procalcitonin

SBP:

Spontaneous bacterial peritonitis

WBC:

White blood cell

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Funding

This work was supported by the Beijing Municipal Science & Technology Commission, Administrative Commission of Zhongguancun Science Park (grant number Z211100002921004), and Clinical Research Special Fund of Wu Jieping Medical Foundation of China (grant number 320.6750.2022–08-1), the Capital Health Research and Development of Special Fund Program (grant number 2022–2-2183).

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Author notes

  1. Jie Han and Fei-li Wei (co-first authors) contributed equally to this work.

Authors and Affiliations

  1. Beijing You’An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China

    Jie Han, Hao-xin Wu, Lu-yao Guo, Ying Han, Ya-nan Sun, Wei Hou & Zhong-jie Hu

  2. Beijing Precision Medicine and Transformation Engineering Technology Research Center of Hepatitis and Liver Cancer, Beijing Institute of Hepatology, Beijing You’An Hospital, Capital Medical University, No. 8 You An Men Wai Street, Fengtai District, Beijing, 100069, China

    Jie Han, Fei-li Wei & Shan Guo

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  1. Jie Han
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Contributions

All authors approved the article. JH (First Author): Conceptualization, Methodology, Formal Analysis, Validation, Visualization Writing-Original Draft. FW (Co-first Author): Conceptualization, Methodology, Resources, Validation. SG: Methodology, Data Curation. HW, LG: Methodology, Resources. YH, YS: Resources. WH (Co-corresponding Author): Supervision, Writing-Review & Editing. ZH (Corresponding Author): Funding Acquisition, Resources, Supervision, Writing-Review & Editing, Project Administration.

Corresponding authors

Correspondence to Wei Hou or Zhong-jie Hu.

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Han, J., Wei, Fl., Wu, Hx. et al. Clinical evaluation of droplet digital pcr for suspected ascites infection in patients with liver cirrhosis. Hepatol Int (2024). https://doi.org/10.1007/s12072-024-10669-3

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