Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis

Abstract

Background/AimsSpontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified.MethodsThis study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed.ResultsThe proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (≥3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictive factors of overall survival rate.ConclusionsHCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.

Predictive model of mortality in patients with spontaneous bacterial peritonitis

“…The multivariate analysis showed that serum urea, blood leucocyte count, Child–Pugh score and mean arterial pressure were independent predictive factors of mortality. These findings are consistent with previous studies and highlight the importance of liver and renal function, sepsis severity, and haemodynamic impairment in the prognosis of SBP.…”

Study of etiology, clinical profile and predictive factors of spontaneous bacterial peritonitis in cirrhosis of liver

“…33 In a study by Tsung PC et al Eschericia coli (12 of the 47 cases, 25.5%), Klebsiella species (9 cases, 19.1%) and Streptococcus species (9 cases, 19.1%) were the most common organisms in this study, Enterococcus species (6 cases, 12.8%). 34 In our study the types of cultured bacterial organisms did not affect the survival rates of cirrhotic patients with SBP.…”

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“…1 Spontaneous bacterial peritonitis is a complication that is life threatening and seen in cirrhotic progress. According to the literature, 8% to 27% of patients admitted with ascites to a hospital have SBP.…”

“…1 No valid parameters to predict SBP-related mortality have been identified. 2 However, if not treated, SBP can be fatal in 50% of patients and serious complications may arise.…”

“…5 However, early diagnosis and early antibiotic treatment has decreased this rate to 20% to 30% in recent years. 1,5 Spontaneous bacterial peritonitis is a monomicrobial infection of ascites, which may occur by infection, translocation, or hematogenous dissemination of intestinal flora. 4 Bacterial trans location is the major mechanism of SBP.…”