Chronic Alcoholic Liver Disease and Mortality Risk in Spontaneous Bacterial Peritonitis: Analysis of 6,530 Hospitalizations

Abstract

Our study aimed to assess the risk of in-hospital mortality due to chronic alcoholic liver disease (CALD) and other comorbidities in spontaneous bacterial peritonitis (SBP) inpatients. MethodsWe conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012 to 2014) from the United States and included 6,530 patients (age 18-50 years) with a primary diagnosis of SBP. Logistic regression was used to evaluate the odds ratio (OR) for in-hospital mortality in SBP by comorbidities. ResultsThe prevalence of CALD in SBP patients is 43.6%, and a higher proportion were males (68.8%) and whites (67%). Middle-aged adults (OR 2.8, 95% CI 1.74-4.45) had higher odds of in-hospital mortality in SBP patients. Race and sex were non-significant predictors for mortality risk. Patients with comorbid coagulopathy (OR 1.9, 95% CI 1.45-2.48) and heart failure (OR 3.9, 95% CI 2.46-6.36) have increased mortality in SBP inpatients. After controlling confounders, CALD was significantly associated with increased in-hospital mortality (OR 1.5, 95% CI 1.12-1.94) in SBP inpatients. ConclusionCALD is an independent factor in increasing the risk of in-hospital mortality in SBP patients by 48%. Alcohol use screening, and alcohol abstinence and supportive therapy need to be implemented at an earlier stage to improve health-related quality of life and reduce in-hospital mortality in SBP patients.

Clinical Significance of Ascitic Fluid Polymorphonuclear Leukocyte (PMN) Percentage in Cirrhosis Patients without Spontaneous Bacterial Peritonitis (SBP)

“…Lastly, the predominance of ALD as the etiology of cirrhosis might limit the generalizability of our study outcome. This is because, although it remains controversial ( 38 ), it has been reported that ALD has a higher risk for the development of SBP and worsened outcomes compared with other etiologies ( 39 – 42 ).…”

Persistent Cannabis Abuse and Risk for Hospitalization for Acute Pancreatitis: A Cross-Sectional Study in United States Hospitals

“…Whites have a higher association of being hospitalized due to AP, whereas blacks, Hispanics, and other races/ethnicities didn't have any significant relationship. It may be because whites are more likely to consume alcohol, which is a potential risk factor for worsening symptoms of AP [12].…”

“…Gallstone exacerbates AP by increasing duct pressure, which leads to unregulated activation of digestive enzymes [13]. Ethanol and its metabolite produce oxidative stress or the generation of fatty acid ethyl esters, leading to inflammation, which may be the reason for causing acute pancreatitis [12]. Simultaneous usage of alcohol and cannabis is found to be nearly twice as common as concurrent use, suggesting that people who reported consuming both did so at the same time [6].…”

Coagulopathy and Hospital Outcomes in Patients With Spontaneous Bacterial Peritonitis: A Call for Action to Improve Care of Inpatients

“…A recent study found that alcohol consumption has a negative effect on the liver affecting the synthesis of coagulation factors such as factors II, V, VII, and X, and fibrinogen, and it impacts the hemostasis and fibrinolytic system [14,15]. An inpatient study by Bhandari et al found that CALD is an independent factor that increases the risk of in-hospital mortality in SBP patients by 48% [16].…”