Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis

Mattos, Ângelo Alves de; Wiltgen, Denusa; Jotz, Raquel F.; Dornelles, Caroline M.R.; Fernandes, Matheus V.; Mattos, Ângelo Zambam de

doi:10.1016/j.aohep.2020.04.010

Cited by 35 publications

(29 citation statements)

References 55 publications

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“…Ascites infection is a frequent concurrent event in patients with cirrhosis and ascites, such as the prevalent spontaneous bacterial peritonitis (SBP) and, less commonly, fungal infections[ 63 , 64 ]. SBP is defined as spontaneous ascites infection in the absence of other causes of secondary peritoneal infection[ 65 ]. The diagnosis is based on the presence of > 250 polymorphonuclear cells/mm 3 in the ascites fluid as the high negative culture rate (up to 60% has been reported)[ 66 , 67 ].…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

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Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

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Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

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“…Bacterial infections occur in 25%–35% of the patients hospitalized with advanced cirrhosis[ 41 ], and they are associated with increased morbidity and mortality[ 42 , 43 ], particularly when acquired in the hospital or in healthcare facilities, due to the presence of multidrug resistant organisms[ 44 - 48 ]. SBP is frequently reported as the most common infection in subjects with cirrhosis and ascites[ 44 , 45 ] and one of the main precipitants of ACLF[ 49 ].…”

Section: Sbpmentioning

confidence: 99%

Albumin administration in patients with cirrhosis: Current role and novel perspectives

Mattos¹,

Simonetto²,

Terra³

et al. 2022

WJG

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Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.

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“…Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid in the absence of an apparent intra-abdominal source. 1 In hospitalized patients with liver cirrhosis and ascites, the incidence rate of SBP ranges from 7-30% thereby making it one of the most common bacterial infections in this subset population. 2 Historically, Gram-negative organisms such as Escherichia coli and Klebsiella have been frequently isolated from ascitic fluid specimens.…”

Section: Introductionmentioning

confidence: 99%

Early readmissions of spontaneous bacterial peritonitis in the USA: Insights into an emerging challenge

Dahiya

Sanaka

Kichloo

et al. 2022

J of Gastro and Hepatol

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Background and Aim: Early readmissions of spontaneous bacterial peritonitis (SBP) are often associated with poor outcomes. We compared characteristics and outcomes for index and 30-day readmissions of SBP in the USA. Methods: We analyzed the Nationwide Readmissions Database for 2018 to identify all adult (≥ 18 years) 30-day readmissions of SBP in the USA. Hospitalization characteristics and outcomes for index and 30-day readmissions of SBP were compared. Independent predictors of 30-day readmissions were also identified. Results: In 2018, of the 5,797 index admissions for SBP, 30% (1726) were readmitted within 30 day. At the time of readmission, the most common admitting diagnosis was alcoholic cirrhosis of the liver with ascites (11.8%) followed by sepsis due to an unspecified organism (9.2%). SBP as an admitting diagnosis was identified for only 8.3% of these 30-day readmissions. Compared with index admissions, 30-day readmissions of SBP had a lower mean age (56.1 vs 58.6 years, P < 0.001) without a statistically significant difference for gender. Furthermore, 30-day readmissions of SBP were associated with significantly higher odds of inpatient mortality (10% vs 4.9%, OR: 2.15, 95% CI: 1.66-2.79, P < 0.001), and mean total hospital charge ($85,031 vs $56,000, mean difference: 29,032, 95% CI: 12,197, P < 0.001) compared with index admissions. The presence of chronic pulmonary disease, liver failure, inpatient dialysis, and discharge against medical advice were identified as independent predictors for increased 30-day readmissions of SBP. Conclusion:The 30-day readmission rate of SBP was 30% and these readmissions were as-

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Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis

Cited by 35 publications

References 55 publications

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Albumin administration in patients with cirrhosis: Current role and novel perspectives

Early readmissions of spontaneous bacterial peritonitis in the USA: Insights into an emerging challenge

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