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Low serum apoA-I levels indicate complications of cirrhosis. We hypothesized that HDL-associated apolipoproteins in ascitic fluid (AF) are differentially abundant during spontaneous bacterial peritonitis (SBP). Serum and non-infected AF samples from 18 patients with cirrhosis (cohort 1) were analyzed using LC\u2013MS\/MS to identify differentially regulated apolipoproteins. In cohort 2, samples from 59 patients with SBP and 59 without were analyzed for AF apoA-II and apoA-I concentrations using ELISA, and cumulative 90-day transplant-free survival was analyzed. Proteomic analysis indicated depletion of AF apoA-II in the absence of SBP. Lower AF apoA-II and apoA-I correlated with lower AF protein and albumin, higher serum bilirubin, and lower platelets. During SBP, AF apoA-II levels significantly increased, leading to higher apoA-II\/apoA-I ratios. AF apoA-II, but not apoA-I, correlated with peritoneal IL-6 concentrations. AF apoA-II\u2009&gt;\u200945\u00a0\u00b5g\/ml during SBP indicated an increased risk of death or transplantation within 90\u00a0days and remained a predictor of transplant or death after adjustment for age and MELD (adjusted hazard ratio, 2.59; 95% CI, 1.08\u20135.91; P\u2009=\u20090.032). In summary, the composition of HDL-associated apolipoproteins in ascites is altered during SBP and correlates with disease course.<\/jats:p>","DOI":"10.1038\/s41598-025-08238-1","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T06:43:34Z","timestamp":1752648214000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The prognostic significance of HDL-associated apolipoproteins in ascitic fluid from patients with cirrhosis and spontaneous bacterial peritonitis"],"prefix":"10.1038","volume":"15","author":[{"given":"Mohamad","family":"Murad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp A.","family":"Reuken","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Rei\u00dfing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatomi","family":"Ibidapo-Obe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karsten","family":"Gro\u00dfe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mick","family":"Frissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederic","family":"Haedge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majda","family":"El-Hassani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"von Bergen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Bruns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"8238_CR1","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/j.jhep.2021.04.022","volume":"75","author":"C Villanueva","year":"2021","unstructured":"Villanueva, C. et al. 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