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Colon Ascendens Stent Peritonitis (CASP) - a Standardized Model for Polymicrobial Abdominal Sepsis
Published on: December 18, 2010
In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model
Sónia Rito Nobre1, José Eduardo Pina Cabral, João José Ferreira Gomes
1Unit of Gastroenterology, Hospital Center of Cascais, Cascais, Portugal. soninobre@hotmail.com
Introduction And Objective:
Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. Model for end-stage liver disease (MELD) relies on a few objective variables and predicts short-term survival. We aimed to determine the predictive value of MELD score, at admission, in the short-term mortality of SBP patients.
Methods:
We conducted a retrospective study of 73 SBP episodes admitted in our department between January 2002 and April 2006. Diagnosis (neutrophil count in ascitic fluid >or=250/mm3) was established within 24 h and cefotaxime was immediately started. Data collected included age, sex, etiology of liver disease, severity of ascites and hepatic encephalopathy, serum creatinine, total bilirubin and albumin, prothrombin time with international normalized ratio, and ascitic fluid analysis.
Statistics:
Student's t-test, chi2 test, univariate analysis, logistic regression model, and receiver operating characteristic curves.
Results:
In-hospital mortality rate was 37%. In multivariate analysis, MELD score (P<0.001), and advanced age (P<0.05) were independent predictors of mortality. Receiver operating characteristic curve for MELD score revealed an excellent discriminatory ability to predict death, with an area under curve of 0.84. Age increased the predictive ability of MELD score, represented by an increment of area under curve to 0.88.
Conclusion:
MELD score and older age were independent predictors of mortality. Age increased the discriminatory ability of MELD score to predict death. This new model may be useful for stratifying patients in future therapeutic trials, deserving further validation.
Insights
The Model for End-Stage Liver Disease (MELD) score and advanced age are key predictors of short-term mortality in patients with spontaneous bacterial peritonitis (SBP). Incorporating age improves the MELD score's predictive accuracy for SBP patient outcomes.
Area of Science:
- Hepatology
- Internal Medicine
- Critical Care Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with liver cirrhosis and ascites.
- Early identification of high-risk SBP patients is critical for improving prognosis and survival rates.
- The Model for End-Stage Liver Disease (MELD) score is a widely used objective measure for predicting short-term survival in liver disease.
Purpose of the Study:
- To evaluate the predictive value of the MELD score upon admission for short-term mortality in patients diagnosed with SBP.
- To assess the combined predictive capability of the MELD score and patient age.
Main Methods:
- A retrospective study analyzed 73 SBP episodes between January 2002 and April 2006.
- Diagnostic criteria included ascitic fluid neutrophil count ≥250/mm³; cefotaxime treatment was initiated promptly.
- Statistical analyses included t-tests, chi-squared tests, univariate analysis, logistic regression, and ROC curves.
Main Results:
- The in-hospital mortality rate for SBP patients was 37%.
- Multivariate analysis identified MELD score (P<0.001) and advanced age (P<0.05) as independent predictors of mortality.
- The MELD score demonstrated excellent discriminatory ability (AUC=0.84); adding age improved prediction (AUC=0.88).
Conclusions:
- Both MELD score and older age independently predict mortality in SBP patients.
- Advanced age enhances the MELD score's discriminatory power for predicting SBP-related death.
- This combined model warrants further validation for stratifying SBP patients in clinical trials.