Predictive model of mortality in patients with spontaneous bacterial peritonitis

Poca, María; Alvarado‐Tapias, Edilmar; Concepción, Mar; Pérez-Cameo, Cristina; Cañete, Núria; Gich, Ignasi; Romero, Cristina; Casas, Meritxell; Román, Eva; Castells, Lluı́s; Vargas, Vı́ctor; Carrión, J.A.; Guarner, Carlos; Soriano, Germán

doi:10.1111/apt.13745

Cited by 25 publications

(26 citation statements)

References 45 publications

(132 reference statements)

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“…The lower mortality rate of our study might be due to the patients being younger (57 vs. 62 years) and the absence of patients with hepatocellular carcinoma. In another study, Poca et al found the in-hospital mortality rate of SBP as 28% and showed that mean arterial pressure, serum leukocyte count, and serum urea levels were related to mortality [27]. Similarly, our study showed that mortality was higher in patients with high serum leukocyte counts.…”

Section: Discussionsupporting

confidence: 79%

Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers

İliaz

Özpolat

Baran

et al. 2018

European Journal of Gastroenterology &Amp; Hepatology

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Section: Discussionsupporting

confidence: 79%

Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers

İliaz

Özpolat

Baran

et al. 2018

European Journal of Gastroenterology &Amp; Hepatology

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“…Severity of liver dysfunction[ 42 , 54 , 56 , 61 , 102 ] including the Child-Pugh score or model for end-stage liver disease (MELD) score has been reported as a predictive factor, but few studies have not found an association of MELD score and the incidence of SBP[ 103 ] in patients with LC and refractory ascites. The MELD score does not include some clinical variables that are evaluated in the Child-Pugh score[ 104 , 105 ]. A PMN count[ 42 , 102 ] and a low protein concentration (< 1.5 g/dL) in the ascitic fluid, which may be related to decreased opsonic activity in the ascitic fluid[ 26 , 54 , 56 ], have also been reported as predictive factors, but the evidence for ascitic fluid protein is not conflicting[ 106 ].…”

Section: Spontaneous Bacterial Peritonitismentioning

confidence: 99%

“…Predictors of mortality in SBP include severe underlying liver disease with a high Child-Pugh[ 48 , 52 , 64 , 96 , 100 , 102 , 104 , 105 , 120 - 122 ] or MELD score[ 47 , 48 , 52 , 104 , 121 - 123 ], renal impairment[ 16 , 52 , 54 , 64 , 65 , 96 , 100 , 124 , 125 ] such as HRS, and onset of severe sepsis[ 96 ]. Some studies did not find differences in the mortality of nosocomial and community-acquired SBP[ 63 ]; others have reported increased mortality in nosocomial compared with community-acquired SBP, which was correlated with the involvement of drug-resistant bacteria[ 4 , 21 , 63 , 65 ].…”

Section: Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review

Shizuma

2018

WJH

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Spontaneous bacterial (SBP) and spontaneous fungal peritonitis (SFP) can be a life-threatening infection in patients with liver cirrhosis (LC) and ascites. One of the possible mechanisms of developing SBP is bacterial translocation. Although the number of polymorphonuclear cells in the culture of ascitic fluid is diagnostic for SBP, secondary bacterial peritonitis is necessary to exclude. The severity of underlying liver dysfunction is predictive of developing SBP; moreover, renal impairment and infections caused by multidrug-resistant (MDR) organism are associated with a fatal prognosis of SBP. SBP is treated by antimicrobials, but initial empirical treatment may not succeed because of the presence of MDR organisms, particularly in nosocomial infections. Antibiotic prophylaxis is recommended for patients with LC at a high risk of developing SBP, gastrointestinal bleeding, or a previous episode of SBP, but the increase in the risk of developing an infection caused by MDR organisms is a serious concern globally. Less is known about SFP in patients with LC, but the severity of underlying liver dysfunction may increase the hospital mortality. SFP mortality has been reported to be higher than that of SBP partially because the difficulty of early differentiation between SFP and SBP induces delayed antifungal therapy for SFP.

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“…Risk factors could be integrated into predictive models of mortality in individuals with SBP so as to further help identify patients in need of more aggressive therapeutic strategies from the very start of the infective process[ 81 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Fiore¹,

Maraolo²,

Gentile³

et al. 2017

WJH

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Spontaneous bacterial peritonitis (SBP) is the most common infection in end-stage liver disease patients. SBP is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm3 without an evident intra-abdominal surgically treatable source. Several mechanisms contribute to SBP occurrence, including translocation of gut bacteria and their products, reduced intestinal motility provoking bacterial overgrowth, alteration of the gut’s barrier function and local immune responses. Historically, Gram-negative enteric bacteria have been the main causative agents of SBP, thereby guiding the empirical therapeutic choice. However, over the last decade, a worryingly increasing prevalence of Gram-positive and multi-drug resistant (MDR) SBP has been seen. Recently, the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria (48%-62%). The overall proportion of MDR bacteria is up to 22%-73% of cases. Consequently, empirical therapy based on third-generation cephalosporins or amoxicillin/clavulanic acid, can no longer be considered the standard of care, as these drugs are associated with poor outcomes. The aim of this review is to describe, with an epidemiological focus, the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present, and illustrate potential targeted therapeutic strategies. An appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem, with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

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Predictive model of mortality in patients with spontaneous bacterial peritonitis

Cited by 25 publications

References 45 publications

Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers

Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers

Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

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