Euroasian journal of hepato-gastroenterology

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VOLUME 14 , ISSUE 2 ( July-December, 2024 ) > List of Articles

Original Article

Predictors of Mortality in Patients with Spontaneous Bacterial Peritonitis

Danish Kumar, Vijesh Kumar, Taha Yaseen, Partab Dawani, Priya Ramesh, Sheena Kumari, Riya Bai, Abdullah Nasir, Hina Ismail, Zain Majid, Abbas Ali Tasneem, Muhammad Q Panezai, Imdad Ali, Nasir Hasan Luck

Keywords : Ascitic fluid lactate, Cirrhosis, Mortality, Predictor, Spontaneous bacterial peritonitis

Citation Information : Kumar D, Kumar V, Yaseen T, Dawani P, Ramesh P, Kumari S, Bai R, Nasir A, Ismail H, Majid Z, Tasneem AA, Panezai MQ, Ali I, Luck NH. Predictors of Mortality in Patients with Spontaneous Bacterial Peritonitis. Euroasian J Hepatogastroenterol 2024; 14 (2):125-128.

DOI: 10.5005/jp-journals-10018-1436

License: CC BY-NC 4.0

Published Online: 27-12-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Despite treatment with antibiotic therapy, spontaneous bacterial peritonitis (SBP) accounts for approximately 20–40% mortality in hospitalized patients. The data is scarce regarding mortality predictors in SBP. Recently, multiple factors have been studied for effectiveness in prognosis prediction in SBP. Therefore, in this study, our main objective was to evaluate the mortality predictors in SBP. Materials and methods: This prospective observational study was conducted at the Department of Hepatogastroenterology, from January 2022 to June 2023. All the patients aged between 18 and 65 years having decompensated chronic liver disease and diagnosed with SBP were enrolled in the study. The excluded population comprised of those who were on hemodialysis, those having history of any solid organ malignancy or transplantation or patients suffering from infections such as those caused by human immunodeficiency virus (HIV) or infections other than SBP. These patients were followed during the hospital stay and after the discharge monthly for 3 months and then at 6 months to assess mortality. Results: A total of 142 cirrhotic patients having SBP were enrolled in the study. Among them, most of them were males [98 (69%)]. Viral hepatitis (65.4%) was the most common cause of cirrhosis in studied population. On univariate analysis, serum total leukocyte count (TLC), international normalized ratio (INR), ascitic TLC, ascitic neutrophils, ascitic lactate, ascitic LDH, CTP score, MELD-Na were significantly higher while serum albumin was significantly lower in the patients who died as compared to those who survived. However, on multivariate cox regression analysis, high serum TLC (p = 0.013), ascitic fluid lactate (p < 0.001) along with high CTP (p = 0.041) and MELD-Na score (p = 0.037) at presentation were the factors that were identified as an independent poor prognostic factors in SBP population. Conclusion: Cirrhotic patients with SBP are at increased risk of mortality. In our study we observed that high prognostic scores such as CTP and MELD-Na at presentation along with increased white blood cell counts and high ascitic fluid lactate levels at presentation are the potential and reliable predictors of mortality in SBP patients.


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  1. Bunchorntavakul C, Chamroonkul N, Chavalitdhamrong D. Bacterial infections in cirrhosis: A critical review and practical guidance. World J Hepatol 2016;8(6):307–321. DOI: 10.4254/wjh.v8.i6.307.
  2. Arvaniti V, D'Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139(4):1246–1256.e1–e5. DOI: 10.1053/j.gastro.2010.06.019.
  3. Piano S, Singh V, Caraceni P, et al. Epidemiology, predictors and outcomes of multi drug resistant (MDR) bacterial infections in patients with cirrhosis across the world. Final results of the “Global study”. Digestive and Liver Disease 2018;50(1Suppl):2–3. DOI: 10.1016/j.dld.2018.01.007.
  4. Nobre SR, Cabral JE, Gomes JJ, et al. In-hospital mortality in spontaneous bacterial peritonitis: A new predictive model. Eur J Gastroenterol Hepatol 2008;20(12):1176–1181. DOI: 10.1097/MEG.0b013e32830607a2.
  5. Hadjivasilis A, Tzanis A, Ioakim KJ, et al. The diagnostic accuracy of ascitic calprotectin for the early diagnosis of spontaneous bacterial peritonitis: Systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2021;33(3):312–318. DOI: 10.1097/MEG.00000000000 01813.
  6. Abdel-Razik A, Eldars W, Elhelaly R, et al. Homocysteine: A new diagnostic marker in spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2018;30(7):779–785. DOI: 10.1097/MEG.0000000000001109.
  7. Abdel-Razik A, Abdelsalam M, Gad DF, et al. Recurrence of spontaneous bacterial peritonitis in cirrhosis: Novel predictors. Eur J Gastroenterol Hepatol 2020;32(6):718–726. DOI: 10.1097/MEG.0000000000001578.
  8. Poca M, Alvarado-Tapias E, Concepción M, et al. Predictive model of mortality in patients with spontaneous bacterial peritonitis. Aliment Pharmacol Ther 2016;44(6):629–637. DOI: 10.1111/apt.13745.
  9. Ahmed A, Morsy KH, Mohammad AN. Prognostic factors of short-term mortality in spontaneous bacterial peritonitis patients. The Egyptian Journal of Hospital Medicine 2022;88(1):4117–4120. DOI: 10.21608/ejhm.2022.255204.
  10. Iliaz R, Ozpolat T, Baran B, et al. Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers. Eur J Gastroenterol Hepatol 2018;30(7):786–791. DOI: 10.1097/MEG.0000000000001111.
  11. Bal CK, Daman R, Bhatia V. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol 2016;8(12):566–572. DOI: 10.4254/wjh.v8.i12.566.
  12. Mani I, Alexopoulos T, Hadziyannis E, et al. An exploratory study of ascitic fluid lactate as prognostic factor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2021;33(1S):e970–e977. DOI: 10.1097/MEG.0000000000002332.
  13. Devani K, Charilaou P, Jaiswal P, et al. Trends in hospitalization, acute kidney injury, and mortality in patients with spontaneous bacterial peritonitis. J Clin Gastroenterol 2019;53(2):e68–e74. DOI: 10.1097/MCG.0000000000000973.
  14. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  15. Drolz A, Horvatits T, Rutter K, et al. Lactate improves prediction of short-term mortality in critically Ill patients with cirrhosis: A multinational study. Hepatology 2019;69(1):258–269. DOI: 10.1002/hep.30151.
  16. Gao F, Huang XL, Cai MX, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: A multicenter study. Aging (Albany NY) 2019;11(13): 4446–4462. DOI: 10.18632/aging.102062.
  17. Kumar D, Yaseen RT, qaiser Panezai M, et al. Ascitic fluid lactate level as a predictor of mortality in cirrhotic patients having spontaneous bacterial peritonitis (SBP). Cureus 2024;16(1):e53243. DOI: 10.7759/cureus.53243.
  18. Mahmud S, Al Kanaani Z, Abu-Raddad LJ. Characterization of the hepatitis C virus epidemic in Pakistan. BMC Infect Dis 2019;19(1):809. DOI: 10.1186/s12879-019-4403-7.
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