{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:52:00Z","timestamp":1793922720156,"version":"4.8.0"},"reference-count":63,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Spontaneous bacterial peritonitis (SBP) represents a significant complication of liver cirrhosis; Gram-positive bacteria (GPB) predominance was recently noted in some areas, with increased antibiotic resistance. Etiology and mortality prediction are important in culture-negative SBP and for empirical antibiotherapy before the arrival of culture results. Methods: A retrospective study was performed on patients with cirrhosis and ascites admitted between 2018 and 2024, divided into culture-positive SBP (Gram-positive and Gram-negative), culture-negative SBP, and non-infected ascites. The NLR (neutrophil-to-lymphocyte ratio) accuracy for the prediction of SBP and in-hospital mortality was estimated using ROC analysis. Results: Overall, 45 culture-positive SBP, 28 culture-negative SBP, and 600 control ascites were diagnosed; Gram-positive SBP represented 60%; median NLR values were significantly higher in patients with Gram-negative compared with Gram-positive SBP (8.79 in Gram-negative versus 3.92 in Gram-positive SBP, AUC 0.752, p = 0.003); and a limited role in SBP prediction was recorded (AUC 0.642, p = 0.003), with no difference between culture-positive and culture-negative SBP. The NLR median values were higher for patients who died in hospital in all patients with cirrhosis, in SBP, and culture-positive SBP, but not in culture-negative SBP. Conclusions: Higher NLR values were associated with Gram-negative SBP etiology and with in-hospital mortality in all cirrhosis, in SBP, and especially in culture-positive and Gram-negative SBP cases. High NLR values can predict the Gram-negative etiology in patients with an ascitic neutrophil count above 250\/mm3, which can be used to guide empirical antibiotherapy until cultures are available or in culture-negative SBP.<\/jats:p>","DOI":"10.3390\/life15091363","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:31:12Z","timestamp":1756373472000},"page":"1363","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Higher NLR Values Can Predict Gram-Negative Spontaneous Bacterial Peritonitis and a High In-Hospital Mortality Rate in Patients with Spontaneous Bacterial Peritonitis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-7683","authenticated-orcid":false,"given":"Sergiu Marian","family":"Cazacu","sequence":"first","affiliation":[{"name":"Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-3838","authenticated-orcid":false,"given":"Ovidiu Mircea","family":"Zlatian","sequence":"additional","affiliation":[{"name":"Microbiology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7578-8048","authenticated-orcid":false,"given":"Dragos Ovidiu","family":"Alexandru","sequence":"additional","affiliation":[{"name":"Statistics Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Leocadia","family":"Plesea","sequence":"additional","affiliation":[{"name":"Microbiology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan Alexandru","family":"Vacariu","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Cimpoeru","sequence":"additional","affiliation":[{"name":"Resident Physician, Emergency Clinic Hospital Craiova, 200642 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion","family":"Rogoveanu","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8003-1750","authenticated-orcid":false,"given":"Camelia Cristiana","family":"Bigea","sequence":"additional","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9956-4318","authenticated-orcid":false,"given":"Cristina Maria","family":"Marginean","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6280-6136","authenticated-orcid":false,"given":"Sevastita","family":"Iordache","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, University of Medicine and Pharmacy Craiova, Petru Rares Street no 2-4, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). 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