Abstract
Background and aimsSpontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis. This study aimed to identify the factors impacting morbidity and short-term mortality in a cohort of patients with cirrhosis following an index episode of SBP.MethodsIn a retrospective study of hospitalized cirrhotic cohort, 333 patient records were reviewed. Demographic, clinical, and laboratory, as well as radiological characteristics of the patient population were analyzed on day 1 of admission. The diagnosis of cirrhosis was based on the combination of laboratory, clinical, and radiological features. The diagnosis of SBP was established by abdominal paracentesis in the presence of cellular, biochemical, and microbiological features consistent with SBP. All independent variables were analyzed to generate a predictive model of mortality by using the Cox proportional hazards regression analysis (adjusted for age and gender).ResultsA total of 61 cirrhotic patients with ascites and a first episode of SBP were identified. The overall mortality among hospitalized patients was 19.7% and was associated with longer length of stay (12.6 vs. 7.6 days; p=0.01). Patient cohorts with multiple antibiotic resistant bacteria as a cause of SBP had a significantly higher mortality compared to those with other bacterial phenotypes (p=0.03). Multivariate analyses showed that a model for end-stage liver disease (MELD) score (hazard ratio [HR]=1.29; 95% CI: 1.10 to 1.92; p=0.023), Child-Turcotte-Pugh score (HR=1.23; 95% CI: 1.05 to 1.82; p=0.027), and acute kidney injury (HR=2.09; 95% CI: 1.41 to 3.47; p=0.01) were the predictors of mortality from SBP.ConclusionSBP predicts in-hospital mortality in cirrhotic patients. In addition to multiple antibiotic resistant bacteria, thresholds of both hepatic and renal injury independently predict adverse outcomes.
Highlights
Cirrhosis is considered a leading cause of morbidity and excess mortality, contributing to as much as over a million deaths annually. [1] This makes it the 11th commonest cause of death worldwide [1]
Multivariate analyses showed that a model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh score (HR=1.23; 95% CI: 1.05 to 1.82; p=0.027), and acute kidney injury (HR=2.09; 95% CI: 1.41 to 3.47; p=0.01) were the predictors of mortality from Spontaneous bacterial peritonitis (SBP)
SPB has been associated with poor prognosis [3], and in spite of the progress made in its management and prevention, the rate of mortality among hospitalized patients ranges from 20% to 30% [4], with one-year mortality rate estimated at up to 50% in some studies [5]
Summary
Cirrhosis is considered a leading cause of morbidity and excess mortality, contributing to as much as over a million deaths annually. [1] This makes it the 11th commonest cause of death worldwide [1]. Spontaneous bacterial peritonitis (SBP) represents one of the common causes of morbidity and excess mortality as a complication of ascites in patients with advanced liver cirrhosis [2]. It is an infection of the ascitic fluid, which almost always occurs in cirrhotic patients without a discernible, surgically treatable source within the abdomen. Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis.
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