Recurrence of spontaneous bacterial peritonitis in cirrhosis: Frequency and predictive factors

Abstract

We investigated whether spontaneous bacterial peritonitis in cirrhosis is a recurrent process and attempted to identify possible predictors of recurrence in 75 consecutive cirrhotics who had recovered from a first episode of spontaneous bacterial peritonitis between January, 1981 and December, 1984 and who were followed closely throughout their illness (follow-up period 10 +/- 13 months; mean +/- S.D.). Thirty-eight patients (51%) developed one or more episodes of spontaneous bacterial peritonitis during follow-up, the probability of recurrence (Kaplan-Meier's method) being 43% at 6 months, 69% at 1 year and 74% at 2 years. Twenty-three variables (age, sex, etiology of cirrhosis, standard liver and renal function tests and characteristics of the first spontaneous bacterial peritonitis) were analyzed as possible predictors of recurrence of spontaneous bacterial peritonitis. In univariate analysis (curves of Kaplan-Meier compared with Mantel-Cox's method), serum bilirubin greater than 4 mg per dl, prothrombin less than or equal to 45% and protein concentration in ascitic fluid less than or equal to 1 gm per dl were significantly (p less than 0.05) associated with a high risk or recurrence of spontaneous bacterial peritonitis. In multivariate analysis (Cox multiple regression model), only ascitic fluid protein concentration (p = 0.005) and prothrombin activity (p = 0.009) were found to be independent predictors of recurrence of spontaneous bacterial peritonitis. Fifty-nine patients (79%) died during follow-up, 18 of them (31%) secondary to spontaneous bacterial peritonitis. The 1-year survival probability in the whole series of patients was 38%.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

“…O uso profilático da norfloxacina de forma mais rotineira nos pacientes com episódio prévio de PBE (42) , nos com proteínas baixa no líquido de ascite (16) e nos com hemorragia digestiva alta, também deveria ter contribuído para a diminuição mais significativa da incidência desta infecção (16,17,33) . Ressalve-se que na reunião do Clube Internacional de Ascite, onde foram definidos os critérios para o diagnóstico, tratamento e profilaxia da PBE, não houve consenso quanto à realização de profilaxia primária a pacientes com proteínas baixas no líquido de ascite (35) .…”

“…A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .…”

Trimethoprim-sulfamethoxazole versus norfloxacin in the prophylaxis of spontaneous bacterial peritonitis in cirrhosis

“…Among death causes are digestive hemorrhage, liver failure, and renal failure (25,38,46) . The 1-year survival rate after the first episode of SBP is 30%-45% (45) , the recurrence of infection being common (about 65% in 1 year) (38) . In our community, SBP is the third leading cause of death in patients with cirrhosis and ascites (26) .…”

Spontaneous Bacterial Peritonitis in Asymptomatic Outpatients With Cirrhotic Ascites

“…In this group, SBP may be complicated by renal failure, systemic sepsis, recurrence, and diminished survival. [1][2][3] The prevalence of SBP in hospitalized patients with cirrhosis and ascites is between 10% and 30%. [4][5][6] The prevalence and outcome of SBP in asymptomatic outpatients with cirrhotic ascites has been less well studied.…”