Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: serum albumin as an easy but reliable predictive factor

“…In a study by Huang CH et al, using the cutoff point for serum albumin level of 2.85 g/dl as a predictor for recurrence of SBP, the sensitivity was 70.2% and the specificity was 76.3%. 14 Weinstein MP, et al studied 28 cases of spontaneous bacterial peritonitis over a period of 5 years and found that mortality was considerably higher in patients with serum albumin lower than 2.5 g/dl. It is suggested from these studies that serum albumin < 2.5gm/dl is significantly associated with adverse prognostic effects, for instance recurrence of SBP and mortality rate is increased.…”

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To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

et al. 2017

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Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl.

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“…Patients with cirrhosis are susceptible to a variety of complications, and their life expectancy can be markedly reduced, especially in those with acute on chronic liver failures23. Infections, especially bacterial infections, account for the major causes for decompensating liver cirrhosis4 or acute on chronic liver failure, and contribute towards high morbidity and mortality of these patients56.…”

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Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

Huang

Jeng

et al. 2016

Sci Rep

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Patients with liver cirrhosis are susceptible to infections with high short-term mortalities. One CD97-related EGF-TM7 molecule, EMR2 (EGF-like molecule containing mucin-like hormone receptor 2), had been shown to regulate human neutrophil function, potentiate systemic inflammation. Nevertheless, EMR2 could also suppress neutrophil survival. Studying the role of EMR2 on neutrophil would be intriguing. 48 healthy volunteers and 100 cirrhotic patients were enrolled. Neutrophils were isolated from peripheral blood and cell surface markers were measured by flow cytometry.EMR2 expression levels correlated with CTP scores and increased further in patients with infections. These EMR2-expressed neutrophils were with activated phenotype, but with deranged functions like increased resting oxidative burst and impaired phagocytosis ability. Ligation of EMR2 could increase the phagoburst capacity but not the phagocytosis ability. Furthermore, neutrophils with higher EMR2 expression were more apoptotic and lost the LPS-induced neutrophil survival. Finally, EMR2 expressions on neutrophils correlated with infections and their levels greater than 25 had an AUC = 0.708 for predicting mortality. In conclusion, EMR2 expression levels correlated with CTP scores and increased further in cirrhotic patients with infections. These high EMR2-expressed neutrophils had activated phenotype but with deranged functions. Higher levels of these EMR2-expressed neutrophils correlated with infectious complications and predict mortality.

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Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: serum albumin as an easy but reliable predictive factor

Abstract: Spontaneous bacterial peritonitis was associated with high sepsis-related mortality in cirrhotic patients. Serum albumin before discharge was a useful single parameter to predict the recurrence of SBP and long-term survival.

Cited by 32 publications

References 31 publications

A randomized open label study of ‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis

A randomized open label study of ‘imipenem vs. cefepime’ in spontaneous bacterial peritonitis

To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

Increased EMR2 expression on neutrophils correlates with disease severity and predicts overall mortality in cirrhotic patients

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