Liver‐specific scores as predictors of mortality in spontaneous bacterial peritonitis

Jacques, Raquel de Oliveira Coberllini; Massignan, L; Winkler, Martina; Balbinot, Rafael Sartori; Balbinot, Raul Angelo; Soldera, Jonathan

doi:10.1002/ygh2.419

Cited by 9 publications

(7 citation statements)

References 36 publications

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“…36,37 Also, in another study, a mortality of 65% was described for ACLF patients diagnosed with Spontaneous Bacterial Peritonitis. 38 Since a gold-standard score for predicting mortality in AOVH is unavailable, a few models have been developed for the prognostication of AOVH, such as the Glasgow Blatchford Score, Almela score, AIMS65 score, Rockall score, Baylor Bleeding score and Cedars-Sinai Medical Center predictive index. [39][40][41][42][43] Nevertheless, these scores are not specific for cirrhotic patients with AOVH.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

et al. 2021

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Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

et al. 2021

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“…Mortality rates are currently around 38%, with 30% of deaths due to infection[ 28 ]. Liver-specific scores, such as the CLIF-SOFA, CLIF-C Acute-on-Chronic Liver Failure (ACLF), and CLIF-C acute decompensation, have been developed to predict mortality in severely decompensated cirrhosis patients[ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

Ndomba,

Soldera

2023

World J Hepatol

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BACKGROUND Sepsis is a severe medical condition that occurs when the body's immune system overreacts to an infection, leading to life-threatening organ dysfunction. The "Third international consensus definitions for sepsis and septic shock (Sepsis-3)" defines sepsis as an increase in sequential organ failure assessment score of 2 points or more, with a mortality rate above 10%. Sepsis is a leading cause of intensive care unit (ICU) admissions, and patients with underlying conditions such as cirrhosis have a higher risk of poor outcomes. Therefore, it is critical to recognize and manage sepsis promptly by administering fluids, vasopressors, steroids, and antibiotics, and identifying and treating the source of infection. AIM To conduct a systematic review and meta-analysis of existing literature on the management of sepsis in cirrhotic patients admitted to the ICU and compare the management of sepsis between cirrhotic and non-cirrhotic patients in the ICU. METHODS This study is a systematic literature review that followed the PRISMA statement's standardized search method. The search for relevant studies was conducted across multiple databases, including PubMed, Embase, Base, and Cochrane, using predefined search terms. One reviewer conducted the initial search, and the eligibility criteria were applied to the titles and abstracts of the retrieved articles. The selected articles were then evaluated based on the research objectives to ensure relevance to the study's aims. RESULTS The study findings indicate that cirrhotic patients are more susceptible to infections, resulting in higher mortality rates ranging from 18% to 60%. Early identification of the infection source followed by timely administration of antibiotics, vasopressors, and corticosteroids has been shown to improve patient outcomes. Procalcitonin is a useful biomarker for diagnosing infections in cirrhotic patients. Moreover, presepsin and resistin have been found to be reliable markers of bacterial infection in patients with decompensated liver cirrhosis, with similar diagnostic performance compared to procalcitonin. CONCLUSION This review highlights the importance of early detection and management of infections in cirrhosis patients to reduce mortality. Therefore, early detection of infection using procalcitonin test and other biomarker as presepsin and resistin, associated with early management with antibiotics, fluids, vasopressors and low dose corticosteroids might reduce the mortality associated with sepsis in cirrhotic patients.

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“…Therefore, to classify this group as “low” risk and in need of less intensive monitoring or treatment appears inappropriate. In a larger study by de Oliveria Coberllini Jacques et al [ 10 ], although the optimum MELD-Na cut-off was similar (>19), its specificity was still extremely poor (0.43), suggesting several deaths were observed in patients with scores below this threshold. Whilst future studies are required to better elucidate if MELD-Na, in particular, may have a role in the risk-stratification of this cohort, these results appear to support EASL guidelines that patients who develop SBP are not currently risk-stratified for treatment decisions; all should receive broad-spectrum antibiotics and intravenous albumin [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Due to impaired local [ 5 ] and systemic [ 6 ] immune defences, these microorganisms, most commonly Gram-negative enteric bacteria [ 7 ] may not be killed effectively and therefore can colonise the ascitic fluid [ 4 ]. Presentation with SBP varies; some patients are asymptomatic and are diagnosed incidentally during large-volume paracentesis [ 8 ] whereas others present with severe sepsis and multiorgan failure [ 9 , 10 ]. Despite vast improvements in the early diagnosis and treatment of SBP [ 11 ], the short-term prognosis is poor; in-hospital and 90-day mortality is 36% and 45% respectively [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…At present, few studies have formally evaluated the predictive accuracy of MELD in patients with cirrhosis and SBP and the results so far have been conflicting [ 10 , 20 , 21 ] both when multivariate analysis has been utilised to determine whether MELD is an independent predictor of mortality, and when the model’s discriminatory ability has been evaluated using receiver operator characteristic (ROC) curves. Identifying prognostic scores with high predictive accuracy in this cohort may allow patients to be risk-stratified to help identify, alongside clinical judgement, those which require closer monitoring or more intensive treatment.…”

Section: Introductionmentioning

confidence: 99%

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The Usefulness of Mayo End-stage Liver Disease (MELD) and MELD-Sodium (MELD-Na) Scores for Predicting Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis

Coxeter-Smith¹,

Al-Adhami²,

Alrubaiy³

2023

Cureus

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Background: Spontaneous bacterial peritonitis (SBP) is a common infection in patients with cirrhosis and ascites. Currently, the accuracy of the model for end-stage liver disease (MELD) and MELD-sodium (MELD-Na) as prognostic scores in this cohort is unclear. This study aimed to evaluate and compare the accuracy of MELD and MELD-Na for predicting 90-day mortality and determine whether the mortality risk estimates they provide accurately reflect the poor prognosis of patients with SBP Methods: Patients with cirrhosis and SBP were retrospectively identified from ascitic fluid samples sent for microscopy, culture and sensitivity analysis (1/1/18-31/12/20) and a previous audit. MELD and MELD-Na scores at diagnosis were calculated and associations with 90-day mortality were assessed using univariate analysis. Receiver operator characteristic curves were compared, and standardised mortality ratios (SMRs) were calculated by comparing the number of deaths observed to the number predicted by MELD and MELD-Na. Results: Of the 567 patients identified, 15 patients with cirrhosis and SBP were included. The 90-day mortality rate was 66.7% (10/15). Only concurrent hyponatremia (<135mmol/L) was associated with mortality (6/10 non-survivors vs 0/5 survivors, p=0.04). The difference in MELD and MELD-Na’s C-statistic was not significant: 0.66 (95% Cl:0.35-0.98) vs 0.74 (95% Cl:0.47-1.0) respectively (p=0.72). Patients with a MELD-Na >18.5 had significantly higher 90-day mortality than patients with MELD-Na ≤18.5 (88.9% (8/9) vs. 33.3% (2/6), p=0.05). The SMR (95% Cl) for each MELD decile evaluated was 33.3 (0-79.5), 11.1 (0.2-22.0) and 3.4 (0-7.0) for scores ≤9,10-19 and 20-29 respectively. For each MELD-Na tertile, these were: 25 (0-59.6), 5.2 (0.1-10.3) and 2.7 (0.1-8.1) for scores <17,17-26, ≥27 respectively. Conclusion: In a small cohort of patients with cirrhosis and SBP, the MELD’s accuracy in predicting 90-day mortality was limited. MELD-Na’s accuracy was higher but not significantly. Both scores consistently underestimated participants’ mortality, therefore future studies could evaluate the accuracy of alternative prognostic scores in this patient group.

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Liver‐specific scores as predictors of mortality in spontaneous bacterial peritonitis

Cited by 9 publications

References 36 publications

Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

The Usefulness of Mayo End-stage Liver Disease (MELD) and MELD-Sodium (MELD-Na) Scores for Predicting Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis

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