Year 2018 / Volume 110 / Number 2
Original
Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study

94-101

DOI: 10.17235/reed.2017.4517/2016

Luigi Melcarne, Julia Sopeña, Francisco José Martínez-Cerezo, Mercedes Vergara, Mireia Miquel, Jordi Sánchez-Delgado, Blai Dalmau, Salvador Machlab, Dustin Portilla, Yonaisy González-Padrón, Mónica Real Álvarez, Chantal Carpintero, Meritxell Casas,

Abstract
Introduction: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. Objective: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. Patients and methods: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. Results: A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). Conclusions: 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.
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References
1. Conn HO. Spontaneous peritonitis and bacteremia in Laennec’s cirrhosis by enteric organism. A relatively common but rarely recognized syndrome. Ann Intern Med. 1964;60:568-80.
2. Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis--bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther. 2015;41(11):1116-31.
3. Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology. 2005;41(3):422-33.
4. Ra G, Tsien C, Renner EL, Wong FS. The Negative Prognostic Impact of a First Ever Episode of Spontaneous Bacterial Peritonitis in Cirrhosis and Ascites. J Clin Gastroenterol. 2015;49(10):858-65.
5. Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2011;9(3):260-5.
6. Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, Hou LA, Sheibani S, et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 2014;109(9):1436-42.
Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 2001;96(4):1232-6
8. Nobre SR, Cabral JE, Gomes JJ, Leitao MC. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model. Eur J Gastroenterol Hepatol. 2008;20(12):1176-81.
9. Khan J, Pikkarainen P, Karvonen AL, Makela T, Peraaho M, Pehkonen E, et al. Ascites: aetiology, mortality and the prevalence of spontaneous bacterial peritonitis. Scand J Gastroenterol. 2009;44(8):970-4.
10. Merino Rodriguez B, Nunez Martinez O, Diaz Sanchez A, Fernandez Yunquera A, Pajares Diaz JA, Matilla Pena A, et al. [Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice]. Gastroenterol Hepatol. 2008;31(9):560-5.
11. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care. 2007;11(2):1.
12. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-9.
13. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797-805.
14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
15. Guidelines CP. Clinical Practice Guidelines EASL clinical practice guidelines on the management of ascites , spontaneous bacterial peritonitis , and hepatorenal syndrome in cirrhosis Clinical Practice Guidelines. 2010;53(May):397-417.
16. Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A, et al. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites. Liver Int. 2015;35(9):2121-8.
17. Tandon P, Kumar D, Seo YS, Chang HJ, Chaulk J, Carbonneau M, et al. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Am J Gastroenterol. 2013;108(9):1473-9.
18. Tsung PC, Ryu SH, Cha IH, Cho HW, Kim JN, Kim YS, et al. Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. Clin Mol Hepatol. 2013;19(2):131-9.
19. Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60(6):1310-24.
20. Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol. 2014;4(4):302-11.
21. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403-9.
22. Cohen MJ, Sahar T, Benenson S, Elinav E, Brezis M, Soares-Weiser K. Antibiotic prophylaxis for spontaneous bacterial peritonitis in cirrhotic patients with ascites, without gastro-intestinal bleeding. Cochrane Database Syst Rev. 2009(2):Cd004791.
23. Fernandez J, Navasa M, Planas R, Montoliu S, Monfort D, Soriano G, et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology. 2007;133(3):818-24.
24. Odena G, Miquel M, Serafin A, Galan A, Morillas R, Planas R, et al. Rifaximin, but not growth factor 1, reduces brain edema in cirrhotic rats. World J Gastroenterol. 2012;18(17):2084-91.
25. Senzolo M, Cholongitas E, Burra P, Leandro G, Thalheimer U, Patch D, et al. beta-Blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. Liver Int. 2009;29(8):1189-93.
26. Min YW, Lim KS, Min BH, Gwak GY, Paik YH, Choi MS, et al. Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites: a propensity score matched cohort study. Aliment Pharmacol Ther. 2014;40(6):695-704.
27. Deshpande A, Pasupuleti V, Thota P, Pant C, Mapara S, Hassan S, et al. Acid-suppressive therapy is associated with spontaneous bacterial peritonitis in cirrhotic patients: a meta-analysis. J Gastroenterol Hepatol. 2013;28(2):235-42.
28. Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, et al. Nonselective beta blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146(7):1680-90.e1.
29. van Vlerken LG, Huisman EJ, van Hoek B, Renooij W, de Rooij FW, Siersema PD, et al. Bacterial infections in cirrhosis: role of proton pump inhibitors and intestinal permeability. Eur J Clin Invest. 2012;42(7):760-7.
30. de la Coba Ortiz C, Arguelles Arias F, Martin de Argila de Prados C, Judez Gutierrez J, Linares Rodriguez A, Ortega Alonso A, et al. Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Espanola de Patologia Digestiva. Rev Esp Enferm Dig. 2016;108(4):207-24.
31. Pelletier G, Salmon D, Ink O, Hannoun S, Attali P, Buffet C, et al. Culture-negative neutrocytic ascites: a less severe variant of spontaneous bacterial peritonitis. J Hepatol. 1990;10(3):327-31.
32. Cho JH, Park KH, Kim SH, Bang JH, Park WB, Kim HB, et al. Bacteremia is a prognostic factor for poor outcome in spontaneous bacterial peritonitis. Scand J Infect Dis. 2007;39(8):697-702.
33. Barreales M, Fernandez I. Spontaneous bacterial peritonitis. Rev Esp Enferm Dig. 2011;103(5):255-63.
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Melcarne L, Sopeña J, Martínez-Cerezo F, Vergara M, Miquel M, Sánchez-Delgado J, et all. Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study. 4517/2016


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Publication history

Received: 28/06/2016

Accepted: 29/08/2017

Online First: 09/01/2018

Published: 31/01/2018

Article revision time: 423 days

Article Online First time: 560 days

Article editing time: 582 days


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