15. Predictors of recurrent spontaneous bacterial peritonitis in patients with cirrhosis of liver

Abstract

Background and Aims: Spontaneous bacterial peritonitis (SBP) a common bacterial infection with high mortality is an important milestone in the natural history of Chronic liver disease. The problem of recurrent SBP is emerging and studies on the risk factors of recurrent SBP are limited. We aim to assess the factors responsible for recurrent SBP in hospitalized cirrhosis patients and to study the impact of recurrent SBP on mortality. Methods: This is a prospective cohort study done over one year, where patients admitted with SBP were enrolled and their clinical, endoscopic, biochemical parameters and survival time were analyzed. Results: There were 111 cases of SBP of which 45 (40.5%) were recurrent SBP. The whole study group was divided into two groups based on first episode and recurrent SBP. Univariate analysis showed presence of fever on admission (p = 0.04), history of ascites (p = 0.00), history of other infections (p = 0.05), hepatic encephalopathy (p = 0.016), diuretic use (p = 0.00), SBP prophylaxis (0.00), recent (<30 days) antibiotic use (p = 0.04), repeated therapeutic paracentesis (p = 0.00), higher Child Pugh score (p = 0.001), MELD score (p = 0.00), higher grade of esophageal varix (p = 0.031), presence of portal hypertensive gastropathy [PHG] (p = 0.00), bilirubin level (p = 0.00), Serum creatinine (p = 0.05), ascitic fluid albumin (p = 0.005) were significantly different between the groups. Using logistic regression model for multivariate analysis PHG, ascitic fluid albumin, bilirubin were independent predictors of recurrent SBP, [p = 0.001, odds ratio (OR) = 0.086, 95% confidence interval (CI) 0.023–0.354 for PHG; p = 0.03 OR = 3.84; 95% CI, 1.11–13.96 for ascitic fluid albumin and p = 0.043 OR = 0.28, 95% CI, 0.074–0.986 for bilirubin]. The mortality was 73.3% (33/45) in recurrent group (p = 0.009). Kaplan Meir survival with Cox regression analysis showed mean survival of 379 ± 61 in first SBP group as compared to 99 ± 8 in recurrent group (p = 0.04). Conclusions: Recurrent SBP is associated with high mortality and lesser survival as compared to single episode of SBP. Presence of PHG, ascitic fluid albumin, serum bilirubin can be useful to predict the recurrence of SBP. The author has none to declare.