Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study

Abstract

Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival.

Predictors of Short-Term Mortality Following First Episode of Spontaneous Bacterial Peritonitis in Hospitalized Cirrhotic Patients

“…It is estimated to represent around 25% to 31% of all infections in these patients and a prevalence ranging from 10% to 30% in inpatient cirrhotic cohorts with ascites [ 5 ]. The occurrence of first episode of SBP is considered an inflection point in the natural history of cirrhosis and ascites, denoting further decompensation and profound impact on survival (even after resolution of SBP) [ 3 ]. The 30-day in-hospital mortality of SBP is variable but has been reported to be anywhere between 18% [ 17 ] and up to 31.9% [ 16 ].…”

“…Development of hepatic encephalopathy and septic shock were also associated with increased short-term mortality in our study. Impairment of liver function, as suggested by the MELD score, was reported as a good predictor of mortality in SBP in several studies throughout the literature [ 3 ]. Several MELD values, such as 16.5 [ 3 ], 20.5 [ 21 ], and 22 [ 22 ], have been suggested as optimal cut-off points for predicting a worse prognosis in these cohorts of patients.…”

“…SPB has been associated with poor prognosis [ 3 ], and in spite of the progress made in its management and prevention, the rate of mortality among hospitalized patients ranges from 20% to 30% [ 4 ], with one-year mortality rate estimated at up to 50% in some studies [ 5 ]. Several factors have been reported to impact mortality in this cohort of patients.…”

“…These include nosocomial infections, sepsis and septic shock, acute kidney injury (AKI) [ 6 , 7 ], and diagnosis as well as need for hospitalization [ 5 ], among others. The Child-Turcotte-Pugh (CTP) scores and the model for end-stage liver disease (MELD) are among the range of predictive algorithms that are suggested as predictors of mortality in hospitalized patients with cirrhosis and SBP [ 3 , 8 ].…”

Αξιολόγηση της κλινικής σημασίας της ανίχνευσης βακτηριακού DNA στο αίμα και στο ασκιτικό υγρό με τη χρήση πραγματικού χρόνου αλυσιδωτής αντίδρασης πολυμεράσης (Real time polymerase chain reaction -PCR) σε νοσηλευόμενους κιρρωτικούς ασθενείς με ισχυρή υποψία λοίμωξης

“…Παράγοντες κινδύνου είναι η βαρύτητα της ηπατικής νόσου και η κίρρωση αιθυλικής αλκοόλης [121]. Ο συχνότερα ταυτοποιούμενος μύκητας είναι η Αναφορικά με τους παράγοντες κινδύνου ενδονοσοκομειακής θνητότητας, πέραν όσων αναφέρθηκαν για τις λοιμώξεις γενικά, στις μελέτες της ΑΒΠ αναφέρονται συγκεκριμένα δείκτες βαρύτητας της ηπατικής νόσου όπως η υψηλή τιμή INR[122],το υψηλό MELD score στην εισαγωγή, η παρουσία ηπατοκυτταρικού καρκίνου[123], η ύπαρξη ηπατικής εγκεφαλοπάθειας και η νεφρική δυσλειτουργία [124]. Καθυστέρηση στη διάγνωση άνω των 12 ωρών, οδηγεί σε 2.7 φορές πιο αυξημένη θνητότητα[125] ενώ οι λοιμώξεις από MDR συσχετίζονται με 4 φορές υψηλότερο κίνδυνο θανάτου [7].…”