Jasmohan S Bajaj1, Puneeta Tandon2, Jacqueline G OʼLeary3, Florence Wong4, Scott W Biggins5,6, Guadalupe Garcia-Tsao7, Patrick S Kamath8, Benedict Maliakkal9,10, Michael B Fallon11,12, Jennifer C Lai13, Paul J Thuluvath14, Hugo E Vargas15, Ram M Subramanian16, Leroy R Thacker1, K Rajender Reddy17. 1. Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA. 2. University of Alberta, Edmonton, Alberta, Canada. 3. Dallas VA Medical Center and Baylor University Medical Center, Dallas, Texas, USA. 4. University of Toronto, Toronto, Ontario, Canada. 5. University of Washington, Seattle, Washington, USA. 6. University of Denver, Denver, Colorado, USA. 7. Yale University Medical Center, West Haven, Connecticut, USA. 8. Mayo Clinic, Rochester, Minnesota, USA. 9. University of Tennessee, Memphis, Tennessee. 10. University of Rochester, Rochester, New York, USA. 11. University of Arizona, Phoenix, Arizona, USA. 12. University of Texas, Houston, Texas, USA. 13. University of California, San Francisco, California, USA. 14. Mercy Medical Center, Baltimore, Maryland, USA. 15. Mayo Clinic, Scottsdale, Arizona, USA. 16. Emory University Medical Center, Atlanta, Georgia, USA. 17. University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVES: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis. METHODS: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin. RESULTS: Among the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients. DISCUSSION: In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.
OBJECTIVES: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis. METHODS: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin. RESULTS: Among the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients. DISCUSSION: In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.
Authors: Tony Bruns; Jack Peter; Philipp A Reuken; Dominik H Grabe; Sonja R Schuldes; Julia Brenmoehl; Jürgen Schölmerich; Reiner Wiest; Andreas Stallmach Journal: Liver Int Date: 2011-06-13 Impact factor: 5.828
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