NOD2 and TLR1 Polymorphisms Predict Spontaneous Bacterial Peritonitis and Mortality in Cirrhotic Patients With Ascites

ABSTRACT Objectives Spontaneous bacterial peritonitis (SBP) is a severe infectious complication of cirrhosis associated with high morbidity and mortality. Genetic variations in innate immune receptors may influence susceptibility to infection. This study evaluated the association of TLR1 (rs4833095, rs5743551) and NOD2 (rs2066844, rs2066845, rs2066847) polymorphisms with SBP development and mortality in patients with decompensated cirrhosis and ascites. Methods This prospective cohort study included 280 cirrhotic patients at a tertiary gastroenterology center. After exclusions, 242 patients were analyzed. SBP was diagnosed according to international guidelines. TLR1 and NOD2 polymorphisms were determined using real-time polymerase chain reaction. Logistic regression identified risk factors for SBP development, and Cox proportional hazards models evaluated predictors of mortality. Results SBP occurred in 70 patients (28.9%). Mean follow-up was 16.78 ± 11.67 months. The three-year survival rate was 45.1%, and one-year mortality was 43.8%. Patients with SBP had higher one-year mortality than those without SBP (64.3% vs. 35.5%, p < 0.001). TLR1 rs4833095 and NOD2 polymorphisms (rs2066844, rs2066845, rs2066847) were significantly associated with SBP risk. NOD2 rs2066844, NOD2 rs2066847, and TLR1 rs4833095 were independent SBP predictors. Advanced age, higher MELD score, HCC, and SBP independently predicted mortality. In SBP patients, NOD2 rs2066844 and rs2066847 independently predicted one-year mortality. Conclusion NOD2 and TLR1 variants are linked to SBP and mortality in cirrhosis, highlighting potential genetic risk stratification.