English

Abstract

BACKGROUND Spontaneous bacterial peritonitis (SBP) is frequent, clinically significant and infection associated with frequent complications in cirrhotic patients. Diabetes mellitus (DM) and cirrhosis are prone to infections, increased incidence of infections in combined scenarios need further evaluation. Type 2 diabetes mellitus in patients with liver cirrhosis is five times higher than in the general population. Some studies showed that in patients with liver cirrhosis, DM has been associated with a higher risk for hepatic decompensation, encephalopathy, kidney injury and higher overall mortality. But other studies showed no increase in the incidence of SBP in the diabetic patient with cirrhosis. There is no data regarding the frequency of SBP, a comparison of SBP among diabetics and non-diabetics is available in this region of South India. The objectives of the study were to determine the average frequency of spontaneous bacterial peritonitis (SBP) among patients with diabetes mellitus and non-diabetic mellitus in cirrhosis and compare the frequency of SBP in diabetics and non-diabetics with cirrhosis. METHODS This is a retrospective cross-sectional study conducted in the Department of Gastroenterology, Pushpagiri Institute of medical sciences and research centre, Thiruvalla, from January 2017 to January 2019. The study included consecutive 104 patients out of 194 patients (26 missed for follow up and 64 were repeated admissions). All were in regular follow up (at least once in 12 months), irrespective of antibiotic prophylaxis. Those who missed follow up for more than 12 months were excluded from the study. All variables were ordinal or nominal, statistical calculation was done by using percentages and proportions, chi-square test was used for calculation of the significance in comparison of frequency SBP between diabetics and non-diabetics and p-value < 0.05 taken as significant. RESULTS The study included 104 SBP patients after the exclusion, in which 64 patients were diagnosed with DM as per the guidelines. The overall prevalence of DM and non DM among SBP patients in the present study was found to be 61.5 % and 38.5 % respectively. In diabetic patients, 20 patients had SBP once, 40 patients had two times and 4 patients had 3 times during the study period. It contributed around 31 % with once, 62 % with twice and 6 % with thrice SBP during the study period. The average frequency of SBP and variants was found to be 1.7 (diabetic-1.81, Nondiabetic-1.4) during the study period of 2 years. Comparison of frequency of SBP in diabetics and non-diabetics, p-value was found to be 0.003. CONCLUSIONS Spontaneous bacterial peritonitis frequency is significantly increased in diabetic patients in comparison with non-diabetics in cirrhosis. KEY WORDS SBP: Spontaneous Bacterial Peritonitis, DM: Diabetes Mellitus, Cirrhosis.