Abstract
Spontaneous Bacterial Peritonitis (SBP) is a common and potentially fatal complication of cirrhosis. Multiple variants of this infection have been described during the past decade. Few studies have investigated SBP in Brazil. In order to investigate prospectively prevalence, predictive factors and prognosis of the episode of SBP, we studied 143 in and outpatients with cirrhosis admitted to HUCFF and HUPE between January, 1995 and January, 1996. All patients were submitted to a questionnaire, physical examination, blood analysis and abdominal paracentesis with ascitic fluid analysis. They were followed for a mean follow-up period of 4 months and survival was determined. The prevalence of SBP was 20%. Culture-positive SBP, Culture-negative Neutrocytic Ascites and Bacterascites were identified in 24%, 66% and 10%, respectively. After uni- and multivariate analysis, only anterior gastrointestinal hemorrhage, serum albumin and ascitic fluid C4 reached statistical significance (p = 0.05) as predictive factors for the development of the SBP. The in-hospital and follow-up mortality rates were 33.3% and 53.8% for the SBP patients and 8.5% and 31.9% for the non-SBP patients, respectively (p = 0.01 and p = 0.04). The cumulative probability of survival in the SBP group was significantly lower than the probability of the non-SBP group (p = 0.05). We conclude that SBP is a frequent complication, depends of the severity of liver failure and is a marker for poor prognosis in patients with liver cirrhosis.
Highlights
Spontaneous Bacterial Peritonitis (SBP) is a common and potentially fatal complication of cirrhosis
A mortalidade hospitalar e durante o acompanhento foi de 33,3% e 53,8% para o grupo com Peritonite Bacteriana Espontânea (PBE); 8,5% e 31,9% para o grupo sem PBE; respectivamente (p=0.01 e p=0.04)
A mortalidade hospitalar geral foi de 14,5% (9/62), sendo cinco mortes no grupo da PBE (5/15 – 33,3%), comparados a quatro mortes no grupo sem PBE (4/47–8,5%) (p=0.01)
Summary
Peritonite bacteriana espontânea na cirrose hepática: prevalência, fatores preditivos e prognóstico. Investigar prevalência, fatores preditivos e prognóstico dos episódios de Peritonite Bacteriana Espontânea (PBE) na cirrose hepática. Este estudo tem por objetivos: estabelecer a prevalência de PBE e suas variantes em pacientes com cirrose hepática; investigar o papel preditivo de parâmetros clínicos e laboratoriais para o diagnóstico e estabelecer a mortalidade e o prognóstico dos episódios. No período de janeiro/95 a janeiro/96, foram avaliados, consecutivamente, nos Serviços de Clínica Médica do HUCFF e de Gastroenterologia do HUPE, 143 pacientes que preencheram os critérios de inclusão: cirrose hepática com ascite clinicamente detectável. 10 das 55 variáveis investigadas apresentaram valor significativo para predizer o episódio de PBE na análise univariada: história passada de encefalopatia hepática, hemorragia gastrointestinal (HGI) na semana anterior, classificação de ChildPugh, proteínas e albumina sangüíneas, C3 e C4 do sangue e LA e uréia ao nível de significância de 0,05
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