The detection of
bacterial DNA in serum and ascitic fluid (AF) from patients with
liver cirrhosis and
ascites is interpreted as molecular evidence of intestinal bacterial translocation (BT) and considered sufficient to activate the cellular immune response leading to greater
cytokine synthesis. We studied 34 patients with
liver cirrhosis and culture-negative, non-neutrocytic
ascites [22 patients without
bacterial DNA (group I) and 12 patients with
bacterial DNA (group II)]. History and clinical examination were done with the following investigations at first admission and followed up for 24 weeks: serum and AF tumour
necrosis factor-alpha (
TNF-alpha), AF polymorphonuclear leukocytes, AF cultivation and detection of blood and AF
bacterial DNA. Serum and AF
TNF-alpha were significantly higher in patients with
bacterial DNA compared to those without
bacterial DNA at first admission [54.5+/-22.56 vs 35.2+/-17.97 pg ml(-1) (P=0.02) and 123.2+/-49.32 vs 82.6+/-29.58 pg ml(-1) (P <0.005), respectively]. These changes became highly significant at the end of follow-up of both groups [119.3+/-27.19 vs 40.2+/-16.08 pg ml(-1) (P <0.001) and 518.8+/-91.11 vs 97.6+/-17.81 pg ml(-1) (P <0.001), respectively]. In group II, there was a significant increase in serum and AF
TNF-alpha at the end of follow-up compared to at first admission (P <0.001). The relative risk of death,
hepatorenal syndrome (HRS) and spontaneous bacterial
peritonitis (SBP) was higher in patients with
bacterial DNA compared to those without
bacterial DNA. We conclude that cirrhotic patients with culture-negative, non-neutrocytic
ascites and
bacterial DNA have a significantly higher level of serum and AF
TNF-alpha and higher risk of HRS, SBP and mortality compared to those without
bacterial DNA, suggesting that
bacterial DNA and
TNF-alpha are implicated in these complications of
liver cirrhosis.