Spontaneous Bacterial Peritonitis Research Articles

Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.

Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia. An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05. In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality. The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients with Chronic Liver Disease and Ascites

Chronic liver disease (CLD) contributes significantly to morbidity and mortality around the world. In Pakistan, it is due mainly to infections of Hepatitis B and C. One of the complications of CLD, which is often important for such patients, involves an infection of spontaneous bacterial peritonitis. Asymptomatic spontaneous bacterial peritonitis commonly develops in asymptomatic patients with ascites and is therefore preventable when it develops early. This study will determine the incidence of asymptomatic SBP in patients with CLD and ascites, providing potentially valuable data to support screening protocols for early intervention and improved outcomes. It was a cross-sectional study carried out for six months in the Gastroenterology Department of Sheikh Zayed Hospital, Lahore. A total of 121 CLD patients with ascites, meeting particular inclusion criteria, were assessed. The cases were categorized as asymptomatic SBP if the cultures were positive with more than 10⁵ colonies or more than 250/mm³ polymorphonuclear cells, without fever, pain, or tenderness. The patients were stratified according to age, gender, and Child-Pugh classification. The data were analyzed using SPSS version 24, along with the Chi-square test for correlation between the Child-Pugh class and SBP.The proportion of asymptomatic SBP was at 14.8 % among 121 patients. The patients were older: 66.1%, were mostly more than 50 years old, with a fair sex distribution ratio of 52.1 females against 47.9 males. Patients classified into Child-Pugh Class C constituted the highest proportions of patients with SBP cases of 14.8 % and significant association at p=0.000. Asymptomatic SBP in 14.8% of the patients with CLD and ascites forms the justification for routine screening on hospital admission. Critical importance is placed on detecting asymptomatic SBP because this leads to earlier intervention and a potential reduction in the risk of major complications, particularly in patients classified as Child Class C. Keywords- Frequency, Asymptomatic, Spontaneous Bacterial Peritonitis, Patients Chronic Liver Disease, Ascites

Evaluation of Patients with Hepatic Cirrhosis due to Etiology for the Complication

Objectives: Hepatic cirrhosis is a disease with high mortality. The leading causes of morbidity and mortality in patients with hepatic cirrhosis are disease-associated complications. We aimed to describe the association between the difference in laboratory parameters, complications, and commonly known causes of cirrhosis, such as hepatitis B, hepatitis C, alcoholic liver disease (NASH), and autoimmune hepatitis. Methods: We investigated 541 patients with different etiologies of cirrhosis who applied to a gastroenterology clinic from 2009 to 2018 in Florance Nightingale Hospital. All patients were divided into five groups according to the etiology of cirrhosis, such as hepatitis B, hepatitis C, alcoholic liver disease (ALD), NASH, and autoimmune hepatitis. Biochemical and metabolic parameters were evaluated between five groups. Results: 83 patients with alcoholic liver disease, 242 patients with hepatitis B-associated cirrhosis, 112 patients with hepatitis C-associated cirrhosis, 77 patients with NASH, and 27 patients with autoimmune hepatitis were enrolled. Laboratory parameters due to the etiology of hepatic cirrhosis are shown in Table 2. Ascites and hepatic encephalopathy were statistically higher in alcoholic liver disease, hepatitis B, and NASH cirrhosis, while esophageal variceal bleeding was higher in NASH and autoimmune hepatitis. Spontaneous bacterial peritonitis was statistically higher only in cirrhosis due to autoimmune hepatitis. Conclusion: It is very important to assign complications that may develop in liver cirrhosis and manage them by etiology.

Tubulointerstitial nephritis with IgM-positive plasma cells complicated by liver failure.

Tubulointerstitial nephritis (TIN) is characterized by inflammation of the renal interstitium with the infiltration of immune cells, mainly consisting of T cells. Recently, patients with TIN with the predominant infiltration of immunoglobulin M (IgM)-positive plasma cells were reported, coined IgMPC-TIN. Here we report the case of a 70-year-old woman diagnosed with Fanconi syndrome and renal tubular acidosis. Renal biopsy revealed IgMPC-TIN. Her renal dysfunction and clinical findings improved after corticosteroid therapy. However, the patient died of progressive liver failure and spontaneous bacterial peritonitis. In laboratory tests, viral hepatitis was excluded, and autoantibodies associated with liver diseases were negative. Generally, IgMPC-TIN is often complicated by primary biliary cholangitis (PBC), whereas her autopsy revealed the local infiltration of IgM-positive plasma cells, obliterative portal venopathy, and nodular regenerative hyperplasia in liver. This case is the first demonstration that IgMPC-TIN is also seen in liver disease with nodular regenerative hyperplasia, although IgMPC-TIN is more common in anti-M2 antibody-positive disease.

Enhancing the accuracy and effectiveness of diagnosis of spontaneous bacterial peritonitis in cirrhotic patients: A machine learning approach utilizing clinical and laboratory data

PurposeSpontaneous bacterial peritonitis (SBP) is a bacterial infection of ascitic fluid that develops naturally, without being triggered by any surgical conditions or procedures, and is a common complication of cirrhosis. With a potential mortality rate of 40 ​%, accurate diagnosis and prompt initiation of appropriate antibiotic therapy are crucial for optimizing patient outcomes and preventing life-threatening complications. This study aimed to expand the use of computational models to improve the diagnostic accuracy of SBP in cirrhotic patients by incorporating a broader range of data, including clinical variables and laboratory values. Patients and methodsWe employed 5 machine learning classification methods - Decision Tree, Support Vector Machine, Naive Bayes, K-Nearest Neighbor, and Random Forest, utilizing a variety of demographic, clinical, and laboratory features and biomarkers. ResultsAscitic fluid markers, including white blood cell (WBC) count, lactate dehydrogenase (LDH), total protein, and polymorphonuclear cells (PMN), significantly differentiated between SBP and non-SBP patients. The Random Forest model demonstrated the highest overall accuracy at 86 ​%, while the Naive Bayes model achieved the highest sensitivity at 72 ​%. Utilizing 10 key features instead of the full feature set improved model performance, notably enhancing specificity and accuracy. ConclusionOur analysis highlights the potential of machine learning to enhance the accuracy of SBP diagnosis in cirrhotic patients. Integrating these models into clinical workflows could substantially improve patient outcomes. To achieve this, ongoing multidisciplinary research is crucial. Ensuring model interpretability, continuous monitoring, and rigorous validation will be essential for the successful implementation of real-time clinical decision support systems.

FREQUENCY OF PIPERACILLIN/TAZOBACTAM RESISTANCE IN SPONTANEOUS BACTERIAL PERITONITIS PATIENTS

Spontaneous bacterial peritonitis (SBP) is a serious infection in patients with chronic liver disease, requiring prompt antibiotic therapy. Due to growing resistance to first-line antibiotics like ceftriaxone, piperacillin/tazobactam is often used as a second-line treatment. However, emerging resistance to piperacillin/tazobactam poses a significant clinical challenge. Identifying local resistance patterns is crucial for optimizing treatment, particularly in resource-limited settings like Peshawar, Pakistan. Objective: To determine the frequency of piperacillin/tazobactam resistance among patients with spontaneous bacterial peritonitis at a tertiary care hospital in Peshawar, Pakistan. Methods: This cross-sectional study was conducted over five months at Lady Reading Hospital, Peshawar from 18th April to 18th September. A total of 169 patients aged 16 to 75 years with SBP secondary to chronic liver disease were included using non-probability consecutive sampling. Demographic and clinical data were collected, and ascitic fluid samples were cultured to assess resistance to piperacillin/tazobactam. Data were analyzed using descriptive statistics and chi-square tests to examine associations. A p-value &lt; 0.05 was considered statistically significant. Results: Piperacillin/tazobactam resistance was found in 9.5% (16/169) of SBP patients. Resistance was observed in 8.0% (7/88) of Escherichia coli isolates and 11.1% (9/81) of other bacterial isolates (p = 0.04). Resistance rates were slightly higher in the 46–75 age group (11.0%, 11/100) compared to the 16–45 age group (7.3%, 5/69). Male patients had a resistance rate of 10.2% (11/108), while female patients showed 8.2% (5/61). Conclusion: This study highlights significant resistance to piperacillin/tazobactam among SBP patients in Peshawar, particularly in non-E. coli bacteria. These findings underline the need for personalized antibiotic regimens and ongoing surveillance to address growing antimicrobial resistance in chronic liver disease patients.

Role of CD11b and its Mean Fluorescence Intensity for Follow up of Cirrhotic Ascitic Patents with Spontaneous Bacterial Peritonitis and Their Response to Treatment

Role of CD11b and its Mean Fluorescence Intensity for Follow up of Cirrhotic Ascitic Patents with Spontaneous Bacterial Peritonitis and Their Response to Treatment

Evaluating the positive predictive value of code-based identification of cirrhosis and its complications utilizing GPT-4.

Diagnosis code classification is a common method for cohort identification in cirrhosis research, but it is often inaccurate and augmented by labor-intensive chart review. Natural language processing (NLP) using large language models (LLMs) is a potentially more accurate method. To assess LLMs' potential for cirrhosis cohort identification, we compared code-based versus LLM-based classification with chart review as a "gold standard." We extracted and conducted a limited chart review of 3,788 discharge summaries of cirrhosis admissions. We engineered zero-shot prompts using Generative Pre-trained Transformer (GPT)-4 to determine whether cirrhosis and its complications were active hospitalization problems. We calculated positive predictive values (PPVs) of LLM-based classification versus limited chart review, and PPVs of code-based versus LLM-based classification as a "silver standard" in all 3,788 summaries. Versus gold standard chart review, code-based classification achieved PPVs of 82.2% for identifying cirrhosis, 41.7% hepatic encephalopathy, 72.8% ascites, 59.8% gastrointestinal bleeding, and 48.8% spontaneous bacterial peritonitis. Compared to chart review, GPT-4 achieved 87.8-98.8% accuracies for identifying cirrhosis and its complications. Using LLM as a silver standard, code-based classification achieved PPVs of 79.8% for identifying cirrhosis, 53.9% hepatic encephalopathy, 55.3% ascites, 67.6% gastrointestinal bleeding, and 65.5% spontaneous bacterial peritonitis. LLM-based classification was highly accurate versus manual chart review in identifying cirrhosis and its complications - this allowed us to assess the performance of code-based classification at scale using LLMs as a silver standard. These results suggest LLMs could augment or replace code-based cohort classification and raise questions regarding the necessity of chart review.

Combination of carvedilol with variceal band ligation in prevention of first variceal bleed in Child-Turcotte-Pugh B and C cirrhosis with high-risk oesophageal varices: the ‘CAVARLY TRIAL’

ObjectivesBeta-blockers and endoscopic variceal band ligation (VBL) have been preferred therapies for primary prophylaxis of variceal bleeding. However, the choice of therapy in patients with advanced liver disease with high-risk...

8418 Association of GLP-1 Receptor Agonists and SGLT-2 Inhibitors with Major Adverse Cardiovascular Events and Serious Liver Events among Patients with Type 2 Diabetes and MASLD

Abstract Disclosure: A. Kutz: None. D.J. Wexler: None. J. Liu: None. J.M. Paik: None. E. Patorno: None. Introduction and study question Little is known about the cardiovascular (CV) and hepatic effectiveness of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium–glucose cotransporter 2 inhibitors (SGLT-2i) in people with type 2 diabetes (T2D) and known metabolic dysfunction-associated steatotic liver disease (MASLD) in clinical practice. We assessed the comparative CV and hepatic effectiveness and the safety of GLP-1 RA and SGLT-2i in people with T2D and prevalent MASLD. Methodology Using pooled data from Medicare fee-for-service (2013–2020) and a large U.S. health insurance database (2013-June 2022), we conducted two propensity-score fine stratification weighted cohort studies including adults with T2D and a diagnosis of MASLD who initiated GLP-1RA, SGLT-2i, or dipeptidyl peptidase 4 inhibitors (DPP-4i, reference). Using Cox proportional hazards models, we assessed the primary CV effectiveness composite outcome of acute myocardial infarction, ischemic stroke, hospitalization for heart failure, or all-cause mortality. The primary hepatic effectiveness outcome was a composite of serious liver events (hospitalization for ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, bleeding esophageal varices, hepatic encephalopathy, or liver transplantation). The safety outcome was a composite of severe adverse events (lower limb amputation, non-vertebral fracture, emergency admission for hypoglycemia, or hospitalization for acute kidney injury, diabetic ketoacidosis [DKA], severe genital or urinary tract infection, acute pancreatitis, or biliary event). Major results Compared with DPP-4i (n=17,084 initiators), the hazard ratio (HR) for the primary CV outcome associated with GLP-1 RA (n=13,666 initiators) was 0.67 (95% CI, 0.56 to 0.81), corresponding to an incidence rate difference (IRD) per 1,000 person-years of -21.6 (95% CI, -26.7 to -16.6). The HR for the primary hepatic outcome was 0.47 (95% CI, 0.25 to 0.90), the IRD -2.1 (95% CI -3.4 to -0.9). Similar CV benefits were observed for SGLT-2i (n=11,108) vs DPP-4i (n=16,979), with a HR for the primary CV outcome of 0.82 (95% CI 0.70–0.96) and an IRD of -11.0 (95% CI -16.2 to -5.8). For the primary hepatic outcome, the HR was 0.81 (95% CI 0.45 to 1.44) and the IRD -1.1 (95% CI -2.4 to 0.3). Severe adverse events were not more frequent with GLP-1RA or SGLT-2i compared with DPP-4i. Interpretation and conclusion Among people with T2D and MASLD, the use of GLP-1 RA or SGLT-2i was associated with fewer CV events, vs DPP-4i, while GLP-1 RA also reduced serious liver events. Compared with DPP-4i, GLP-1RA or SGLT-2i were not associated with higher safety adverse event rates. Presentation: 6/2/2024

Laparoscopic peritoneal lavage – a new treatment strategy in spontaneous bacterial peritonitis and liver cirrhosis

Introduction Bacterial infections in cirrhotic patients represent a major clinical problem, occuring 4-5 times more frequently compared to the general population and increasing mortality by leading to acute on chronic liver failure, subsequent decompensation, and multiorgan failure. The study’s purpose is to determine the possibilities of laparoscopy in the treatment of spontaneous bacterial peritonitis with decompensated liver cirrhosis. Materials and methods A retrospective descriptive study was conducted on 82 patients diagnosed with liver cirrhosis and spontaneous bacterial peritonitis, who were admitted to the Constantin Tibirna Surgery department No2, Holy Trinity Municipal Clinical Hospital and the Scientific Research Laboratory of Hepatic Surgery, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, between January 2012 and December 2021. Patients who underwent surgical drainage of the abdominal cavity by laparoscopy with postoperative peritoneal lavage with antibiotics were selected. All patients received standard treatment for the correction of liver function and complications of portal hypertension. The data were extracted from the medical records of the hospital archive, and the patient database was compiled. Data analysis was performed using simple statistical calculations. Results Positive ascitic fluid bacterial culture was in 29.2% (24 patients), while 70.7% (58 patients) had culture-negative ascites and peritonitis. The most frequent bacterial species was E. coli, present in 54.1% (13 patients). Mortality was 8.5% (7 patients) due to progressive liver failure. Recurrence of ascites and peritonitis at 1 month was 6.0% (5 patients). Conclusions The laparoscopic approach in spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis allows for better sanitation of the abdominal cavity, improves peritoneal absorption, and deserves establishment as clinical practice for patients with ascites and peritonitis and cirrhosis.

S4462 A Rare Case of Nephrotic Syndrome Complicated by Spontaneous Bacterial Peritonitis

S4462 A Rare Case of Nephrotic Syndrome Complicated by Spontaneous Bacterial Peritonitis

S1875 The Incidence of Spontaneous Bacterial Peritonitis in Decompensated Cirrhotics With Gastric Antral Vascular Ectasia and Associated Risk Factors

S1875 The Incidence of Spontaneous Bacterial Peritonitis in Decompensated Cirrhotics With Gastric Antral Vascular Ectasia and Associated Risk Factors

STUDY OF SERUM SODIUM LEVELS AND ITS CLINICAL SIGNIFICANCE IN DECOMPENSATED CHRONIC LIVER DISEASE PATIENTS ADMITTED IN A TERTIARY CARE CENTRE OF NORTH EASTERN STATE, TRIPURA

Introduction: Chronic Liver Disease is a major source of death and morbidity globally. Hyponatremia is one of the most common electrolyte abnormalities in chronic liver disease patients. Various studies have established a correlation between serum sodium levels and survival in these patients. Hyponatremia is a marker of severity in CLD patients and studies have shown its relationship with MELD score and Child Pugh score. The complications of DCLD and mortality also increases with hyponatremia. The aim of this study was to study the serum sodium levels in patients with DCLD and to establish its significance. Materials And Methods: Data was collected from 100 patients admitted in medical wards. Patients were divided into 3 groups based on serum sodium levels and the relevant parameters analyzed among the groups. OBSERVATIONS: Among 100 patients, 45 had serum sodium levels ≥136 mEq/L, while 32 had serum sodium levels between 131 and 135 mEq/L and 23 patients had serum sodium level ≤130. No patients had serum sodium levels greater than 145. Serum sodium levels were associated strongly with the severity of liver disease as assessed by Child Pugh and MELD scores. Serum sodium ≤130 indicated the existence of Hepatic Encephalopathy, Hepatorenal Syndrome and Spontaneous Bacterial Peritonitis. Patients with serum sodium less than 130 mEq/L had increased frequency of complications than those with ≥136 mEq/L. Patient with serum sodium levels ≤130 had increased mortality. Conclusion: Hyponatremia is more common in DCLD and low serum sodium levels are associated with increased frequency of complications such as hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis and GI bleeding. Lower serum sodium levels were associated with increased MELD and Child Pugh score and mortality indicating the inverse relationship between serum sodium levels and severity of the disease.

Clinical characteristics and predictors of benign portal vein thrombosis in patients with liver cirrhosis: A retrospective single-center study.

Portal vein thrombosis (PVT) is a common thrombotic complication of cirrhosis. It can lead to variceal bleeding and bowel ischemia and also complicate liver transplantation. Identifying the possible risk factors associated with PVT can aid in identifying patients at high risk, enabling their screening and potentially preventing PVT through the rational use of anticoagulants. This study focuses on examining the clinical characteristics of PVT in cirrhotic patients and identifying the clinical and biochemical factors that are linked to the development of PVT. Consecutive hospitalized cirrhotic patients between 2015 and 2023 were identified through the hospital's computerized medical records based on the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) coding system and retrospectively analyzed. 928 individuals were included in this study; 783 (84.3%) without PVT and 145 (15.7%) with benign PVT. Hepatitis B virus (HBV) was significantly more common in the PVT group (P-value = .02), while alcohol and primary sclerosing cholangitis (PSC) were less common in this group (P-value = .01 and .02, respectively). Hepatocellular carcinoma (HCC) (P-value < .01), ascites (P-value = .01), and spontaneous bacterial peritonitis (SBP) (P-value = .02) were more common in the PVT group. Patients with PVT had a higher international normalized ratio (INR) level (P-value = .042) and lower plasma albumin (P-value = .01). No differences were identified in white blood cell, hemoglobin, platelet, and bilirubin levels. However, patients with PVT had higher model for end-stage liver disease (MELD) (P-value = .01) and Child-Pugh scores (P-value = .03). This study demonstrated a higher likelihood of PVT presence in cirrhotic patients with advanced age, HBV, and HCC, along with ascites, SBP, splenomegaly, hypoalbuminemia, elevated INR, and a higher MELD score. Nevertheless, additional research endeavors are necessary to accurately ascertain and validate supplementary risk factors within a broader demographic.

Rifaximin alone vs combination with norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis with hepatic encephalopathy: randomized controlled trial

BackgroundIn liver cirrhosis, events of spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (HE) portend a poor prognosis. Gut dysbiosis remains a common pathogenetic mechanism for both SBP and HE. Recent data suggests the role of rifaximin in gut modulation and improving intestinal dysbiosis. Due to emergence of multidrug-resistant organisms, gut-selective antibiotics with minimal systemic effects are warranted for secondary prophylaxis in patients of cirrhosis. We compared rifaximin alone vs combination with norfloxacin for secondary prophylaxis of patients of cirrhosis presenting with SBP and HE. This was a prospective, open-label, RCT which included all patients of cirrhosis with SBP and HE on admission. On discharge, in addition to standard medical treatment, patients were randomized to rifaximin 400 mg three times a day (group I) and rifaximin 400 mg three times a day with norfloxacin 400 mg once a day (group II) as a secondary prophylaxis of SBP. Primary outcomes were recurrent episodes of SBP and HE at 6 months and 28-day, 90-day, and 6-month mortalities. Secondary outcomes included number of rehospitalizations, episodes of upper gastrointestinal bleed, new acute kidney injury episodes, and change in Child–Turcotte–Pugh (CTP) and model for end-stage liver disease (MELD) scores over next 6 months.ResultsAfter screening 87 patients of cirrhosis with SBP and HE, 12 patients had in-hospital mortality and another 25 were excluded, one patient was lost to follow-up, and, finally, 49 patients were randomized into group I (n = 24) and group II (n = 25). The HE was grade 2 (18 vs 16) and grade 3 (6 vs 9) in groups I and II respectively. Primary outcomes as recurrent SBP (3 vs 2; P = 0.67); recurrent HE at 6 months (5 vs 2; P = 0.24); and 28-day (2 vs 2; P = 1.0) and 90-day mortality (4 vs 3; P = 0.72) and 6-month mortality (6 vs 8, P = 0.52) were comparable between two groups respectively. Secondary outcomes as number of rehospitalizations (3 vs 8, P = 0.07), new episodes of UGI bleed (2 vs 3, P = 0.1), new AKI episodes (4 vs 1, P = 0.06), ∆CTP (− 4 vs − 4), and ∆MELD (− 9 vs − 8) over the next 6 months were not significantly different between two groups respectively.ConclusionsRifaximin was effective in secondary prevention of both SBP and HE in patients of cirrhosis.Trial registrationThe randomized controlled trial was registered in CTRI/2021/09/036321 dated September 7, 2021.

Diagnostic model for spontaneous bacterial peritonitis in cirrhotic patients with ascites: a multicenter cohort study.

Spontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication of cirrhotic ascites. Early diagnosis and treatment of SBP are essential to improve the survival rates and prognosis of patients. We aimed to identify the predictors of SBP to establish a new noninvasive early diagnostic tool. We screened 1618 patients who underwent paracentesis due to cirrhotic ascites between January 2017 and December 2018 in three hospitals. We evaluated the symptomatic, clinical, and laboratory parameters to identify the predictors of SBP. The primary diagnostic model was displayed as a nomogram. The model included abdominal pain, diarrhea, white blood cell count, neutrophil percentage, procalcitonin, C-reactive protein, lactate dehydrogenase, glucose, and Model for End-stage Liver Disease score. The model's diagnostic performance was good, with an AUC of 0.84 [95% confidence interval (CI), 0.81-0.87] in the training cohort. In the validation cohort, the diagnostic ability was also good, with AUCs of 0.87 (95% CI, 0.83-0.91) and 0.90 (95% CI, 0.87-0.94) for inner and outer validation queues, respectively. Moreover, the decision curve analysis confirmed the clinical utility of the nomogram model. In addition, we developed a Microsoft Excel calculation model to allow convenient adoption of the model in clinical practice. We developed good performing diagnostic models for SBP.

Assessment of Serum-Ascites Vitamin D Gradient (SADG) in Spontaneous Bacterial Peritonitis

Assessment of Serum-Ascites Vitamin D Gradient (SADG) in Spontaneous Bacterial Peritonitis

Frequency of Renal Impairment Among Patients with Liver Cirrhosis with Spontaneous Bacterial Peritonitis

Frequency of Renal Impairment Among Patients with Liver Cirrhosis with Spontaneous Bacterial Peritonitis

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites

Frequency of Asymptomatic Spontaneous Bacterial Peritonitis in Patients of Chronic Liver Disease with Ascites