The 22/11 Risk Prediction Model: A Validated Model for Predicting 30-Day Mortality in Patients With Cirrhosis and Spontaneous Bacterial Peritonitis

Abstract

In cirrhotic patients with SBP receiving standard therapy, MELD score ≥22 and peripheral blood leukocyte count ≥11×10⁹ cells/l are validated independent predictors of mortality. The mortality in a patient without either poor prognostic variable is ≤10% and with both variables is ≥50%. Trials aiming to reduce mortality should target patients in the moderate-risk to high-risk groups.

The ratio of calprotectin to total protein as a diagnostic and prognostic marker for spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites

“…We stratified the patients with SBP in those above and below the median of calprotectin and the ratio to total protein and found significantly different survival when analyzing these two groups in a Kaplan-Meier plot [p = 0.042 for calprotectin and the ratio ( Figure 5B), respectively]. In univariate analysis, presence of HCC (p = 0.008) and, similar to a previous report [18], a MELD score > 21 (p = 0.003) were additionally associated with poor 30-day survival. A multivariate Cox regression analysis on survival revealed that a MELD score > 21 (p = 0.012) and a ratio of calprotein to total protein above the median (p = 0.039), remained independent predictors of poor 30-day survival.…”

“…An excessive inflammatory reaction may be detrimental in the context of liver cirrhosis, a finding that is also suggested in a rat model of SBP [40]. For daily practice, different clinical and blood parameters, including the MELD score, blood leukocyte count and creatinine, but no direct markers of peritoneal infection have been proposed to define the mortality risk for patients with SBP [1,18]. In contrast to ascites cell counts, ascites calprotectin or the ratio to total protein may provide not only diagnostic, but also prognostic information by reflecting the severity of the local peritoneal inflammation.…”

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“…16 In a study of 184 patients, 30-day mortality rate was 27% in patients with a Model for End-Stage Liver Disease score of 20. 2 Our study also included patients in poor condition with correspondingly high Model for End-Stage Liver Disease scores. 2 A limitation of our study was the inability to include patients who met the inclusion criteria but had medical records that were inaccessible or had chronic renal failure.…”

“…2 Our study also included patients in poor condition with correspondingly high Model for End-Stage Liver Disease scores. 2 A limitation of our study was the inability to include patients who met the inclusion criteria but had medical records that were inaccessible or had chronic renal failure. In conclusion, most of our patients were at advanced stage of cirrhosis, with treatment efficiency below our expectations.…”

“…1 No valid parameters to predict SBP-related mortality have been identified. 2 However, if not treated, SBP can be fatal in 50% of patients and serious complications may arise. Spontaneous bacterial peritonitis is a common bacterial infection among patients with cirrhosis, with a prevalence of 10% to 30% in hospitalized patients and 1.5% to 3.5% in patients who are not hospitalized.…”