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Updated: Jul 12, 2026
Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
Published on: December 18, 2010
Association between model for end-stage liver disease and spontaneous bacterial peritonitis
Keith L Obstein1, Mical S Campbell, K Rajender Reddy
1Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Objective:
To determine whether a greater Model for End-Stage Liver Disease (MELD) score is associated with a greater risk of spontaneous bacterial peritonitis (SBP).
Methods:
Our retrospective case-control study enrolled 271 consecutive patients with cirrhosis and ascites who underwent diagnostic paracentesis upon hospital admission (2002-2005). After excluding immunosuppressed patients, those recently exposed to antibiotics, those with a potential confounding etiology for ascites, and those with a prior history of SBP, 111 were included in the study. SBP was defined as a paracentesis yielding>or=250 neutrophils/mL ascites fluid. Multivariable logistic regression was performed to determine the odds ratio for the development of SBP associated with MELD score and grouped MELD score (
Results:
Twenty-nine of 111 hospitalized patients with cirrhosis were found to have SBP. Patient characteristics were similar between groups with and without SBP. The mean MELD score for patients with SBP was 24 and for those without 18 (P=0.0003). The odds ratio for developing SBP by each MELD point was 1.11 (1.05-1.19, P=0.001). Patients with MELD>or=25 had an odds ratio of 9.67 (2.35-39.82, P=0.002) for SBP, compared to subjects with MELD
Conclusions:
Increasing MELD score is independently associated with a greater risk of SBP. For every point increase in the MELD score, the risk of developing SBP increases by 11%. Our finding has important implications for increasing the suspicion of SBP in patients with elevated MELD scores.
Insights
Higher Model for End-Stage Liver Disease (MELD) scores significantly increase the risk of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis. This 11% increased risk per MELD point highlights the need for heightened SBP suspicion in high-MELD patients.
Area of Science:
- Hepatology
- Infectious Disease Epidemiology
- Clinical Risk Stratification
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhosis and ascites.
- Early detection and management of SBP are crucial for improving patient outcomes.
- The Model for End-Stage Liver Disease (MELD) score is a key predictor of mortality in liver disease.
Purpose of the Study:
- To investigate the association between the Model for End-Stage Liver Disease (MELD) score and the risk of developing spontaneous bacterial peritonitis (SBP).
Main Methods:
- A retrospective case-control study included 111 patients with cirrhosis and ascites undergoing diagnostic paracentesis.
- Spontaneous bacterial peritonitis (SBP) was defined by ascitic fluid neutrophil count.
- Multivariable logistic regression analyzed the odds ratio for SBP development concerning MELD score, adjusting for potential confounders.
Main Results:
- Patients with SBP had a significantly higher mean MELD score (24) compared to those without SBP (18).
- Each one-point increase in MELD score was associated with an 11% increased odds of developing SBP.
- Patients with MELD scores ≥25 had a 9.67-fold increased odds of SBP compared to those with MELD scores ≤15.
Conclusions:
- Elevated MELD scores are independently associated with an increased risk of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis.
- The findings underscore the importance of considering SBP in patients presenting with advanced liver disease and high MELD scores.
- This association has significant clinical implications for patient management and risk stratification.
