Circulating cell-free DNA levels increment with worsening cirrhosis severity and associate with platelet exhaustion and mortality

observational cohort, followed for 3 months or until death or transplantation.Results: 225 patients were included (59 ± 12 years, 57% female, HCV ± alcohol etiology in 74%, Child C in 48%, MELD-sodium 21 ± 7, ascites and hepatic encephalopathy in 70 and 38%).Fifty percent of infections were classified as community-based.Skin, SBP and urinary tract i were the most common at admission (25, 23 and 20%).SIRS, qSOFA ≥ 2, and ACLF were observed in 45, 19, and 32 patients.Secondary infection developed in 93 patients (41%) after a median of 11 (7-19) days.The most common secondary infections were respiratory, undetermined site and SBP (27, 23 and 17%).In only 18% of patients the secondary infection developed in same site as the first.The probability of developing secondary infection at the end of the first and second weeks was 12 and 33%.At admission, ACLF (OR 2.84, 95%CI 1.42-5.69,p = 0.003), non-community infections (OR 7.82, 95%CI 1.69-36.12,p = 0.008), as well as Child C and age, were predictors of secondary infections.Patients with secondary infections had higher in-hospital mortality (59 vs. 13%, p < 0.001) as well as at 3 months (64 vs. 26%%, p < 0.001).Development of secondary infection (OR 2.25, 95%CI 1.35-3.73,p = 0.002) and MELD-sodium (OR 1.1, 95%CI 1, 06-1.14, P < 0.001) were independent predictors of 3month mortality.Conclusion: secondary infections are frequent in cirrhotic patients, occurring early and usually in sites other than the index infection.Diagnosis of non-community infections as well as worse liver function at admission were predictors of secondary infections.Development of secondary infections is associated with higher mortality irrespectively of the severity of liver disease.