BACKGROUND: Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. METHODS: Two hundred two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP was included in the study. RESULTS: SBP was detected in 28 of 202 (13.9%) patients; in 26 of 28 patients, the neutrophil count in the ascitic fluid was ≥250 cells/μl, and in 15 of 28 patients, the cultures were positive. Variables independently associated with SBP were as follows: a higher model of end-stage liver disease (MELD) score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall, the median (range) transplant-free survival was 289 (54-1253) days. One hundred (49.5%) patients died, whereas 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were a higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. CONCLUSION: The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rate.
BACKGROUND: Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. METHODS: Two hundred two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP was included in the study. RESULTS: SBP was detected in 28 of 202 (13.9%) patients; in 26 of 28 patients, the neutrophil count in the ascitic fluid was ≥250 cells/μl, and in 15 of 28 patients, the cultures were positive. Variables independently associated with SBP were as follows: a higher model of end-stage liver disease (MELD) score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall, the median (range) transplant-free survival was 289 (54-1253) days. One hundred (49.5%) patients died, whereas 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were a higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. CONCLUSION: The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rate.
Authors: Philipp Schwabl; Theresa Bucsics; Kathrin Soucek; Mattias Mandorfer; Simona Bota; Alexander Blacky; Alexander M Hirschl; Arnulf Ferlitsch; Michael Trauner; Markus Peck-Radosavljevic; Thomas Reiberger Journal: Liver Int Date: 2015-02-18 Impact factor: 5.828
Authors: Salvatore Piano; Virendra Singh; Paolo Caraceni; Rakhi Maiwall; Carlo Alessandria; Javier Fernandez; Elza Cotrim Soares; Dong Joon Kim; Sung Eun Kim; Monica Marino; Julio Vorobioff; Rita de Cassia Ribeiro Barea; Manuela Merli; Laure Elkrief; Victor Vargas; Aleksander Krag; Shivaram Prasad Singh; Laurentius Adrianto Lesmana; Claudio Toledo; Sebastian Marciano; Xavier Verhelst; Florence Wong; Nicolas Intagliata; Liane Rabinowich; Luis Colombato; Sang Gyune Kim; Alexander Gerbes; Francois Durand; Juan Pablo Roblero; Kalyan Ram Bhamidimarri; Thomas D Boyer; Marina Maevskaya; Eduardo Fassio; Hyoung Su Kim; Jae Seok Hwang; Pere Gines; Adrian Gadano; Shiv Kumar Sarin; Paolo Angeli Journal: Gastroenterology Date: 2018-12-13 Impact factor: 22.682
Authors: V V Pavan Kedar Mukthinuthalapati; Samuel Akinyeye; Zachary P Fricker; Moinuddin Syed; Eric S Orman; Lauren Nephew; Eduardo Vilar-Gomez; James Slaven; Naga Chalasani; Maya Balakrishnan; Michelle T Long; Bashar M Attar; Marwan Ghabril Journal: PLoS One Date: 2019-03-06 Impact factor: 3.240