Chronic Alcoholic Liver Disease and Mortality Risk in Spontaneous Bacterial Peritonitis: Analysis of 6,530 Hospitalizations.

Renu Bhandari,Virendrasinh Ravat,Khalida Khaliq,Pawandeep Kaur,Rikinkumar S Patel

doi:10.7759/cureus.8189

Abstract

ObjectiveOur study aimed to assess the risk of in-hospital mortality due to chronic alcoholic liver disease (CALD) and other comorbidities in spontaneous bacterial peritonitis (SBP) inpatients.MethodsWe conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012 to 2014) from the United States and included 6,530 patients (age 18-50 years) with a primary diagnosis of SBP. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in SBP by comorbidities.ResultsThe prevalence of CALD in SBP patients is 43.6%, and a higher proportion were males (68.8%) and whites (67%). Middle-aged adults (OR 2.8, 95% CI 1.74-4.45) had higher odds of in-hospital mortality in SBP patients. Race and sex were non-significant predictors for mortality risk. Patients with comorbid coagulopathy (OR 1.9, 95% CI 1.45-2.48) and heart failure (OR 3.9, 95% CI 2.46-6.36) have increased mortality in SBP inpatients. After controlling confounders, CALD was significantly associated with increased in-hospital mortality (OR 1.5, 95% CI 1.12-1.94) in SBP inpatients.ConclusionCALD is an independent factor in increasing the risk of in-hospital mortality in SBP patients by 48%. Alcohol use screening, and alcohol abstinence and supportive therapy need to be implemented at an earlier stage to improve health-related quality of life and reduce in-hospital mortality in SBP patients.

Highlights

Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid without any previous evidence of intra-abdominal surgery [1]
Chronic alcoholic liver disease (CALD) was significantly associated with increased in-hospital mortality in SBP inpatients
Alcohol abstinence and supportive therapy need to be implemented at an earlier stage to improve health-related quality of life and reduce in-hospital mortality in SBP patients

Summary

Introduction

Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid without any previous evidence of intra-abdominal surgery [1]. Alcohol consumption has increased worldwide and alcohol-related complications range from hepatic steatosis to alcoholic hepatitis to alcoholic cirrhosis and end-stage liver disease [5]. It takes about 10 years to progress, so abstinence is the best way to prevent alcohol-related diseases [6]. Hospital admission in alcoholic liver disease has increased by 18.3% [10] from 2012 to 2016. Chronic alcoholic liver disease (CALD) is diagnosed with a history of heavy alcohol intake; on physical examination, a patient may have signs Dupuytren's contracture, rhinophyma, spider angioma, palmar erythema, jaundice [8]. In CALD, clinical manifestation starts late and the disease spectrum range from alcoholic hepatitis to alcoholic cirrhosis [11]

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Conclusion