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Factors Affecting Mortality and Morbidity of Patients With Cirrhosis Hospitalized for Spontaneous Bacterial
Fatih Ensaroğlu1, Murat Korkmaz, Ali Ümit Geçkil
1From the Department of Gastroenterology, Baskent University Faculty of Medicine, Ankara, Turkey.
Objectives:
Spontaneous bacterial peritonitis, unless originating from surgery or an intra-abdominal source, is an infection diagnosed by neutrophil counts greater than 250/mm³ in ascites. Spontaneous bacterial peritonitis is the most common infection among patients hospitalized with cirrhosis, with a prevalence of 9% and a risk of development among all patients with cirrhosis within 1 year of 10%. No valid parameters have been defined to predict the mortality related to spontaneous bacterial peritonitis. Unless it is treated, the mortality rate as a result of spontaneous bacterial peritonitis is 50%, and serious complications may arise.
Materials And Methods:
Medical records from 29 patients on the deceased-donor transplant waiting list and receiving treatment at the Başkent University Hospital Gastroenterology Clinic for cirrhotic ascites infection between 1996 and 2013 were analyzed. Demographic information, paracentesis findings, clinical follow-up, and treatment results were reviewed and collected from patient medical records, with data recorded to the research form.
Results:
In our patient group, 72.4% were men and the average age was 46.6 years. Most of our patients were at advanced stage, with 55.2% having a Child-Pugh score of C and an average Model for End-Stage Liver Disease score of 17 ± 4.1. We found that 34.5% of the patients received prophylactic treatment for spontaneous bacterial peritonitis, 72.4% received a proton pump inhibitor, and 82.8% had treatment with intravenous albumin support at the time of diagnosis. Albumin treatment showed no effect on mortality. Mortality rate among patients with Child-Pugh score of C was 81.3%.
Conclusions:
Existence of chronic renal failure, liver graft surgery, and hepatocellular cancer did not seem to have a significant effect on patient mortality. The albumin treatment protocol showed no significant difference despite common belief among physicians.
Insights
Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis patients. This study found that advanced liver disease (Child-Pugh C) significantly increases SBP mortality, while albumin treatment showed no impact.
Area of Science:
- Hepatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is a frequent complication in hospitalized cirrhosis patients, with a 9% prevalence and a 10% annual incidence.
- SBP carries a 50% mortality rate if untreated and lacks established predictive parameters for mortality.
- Identifying factors influencing SBP mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze mortality predictors in cirrhotic patients diagnosed with spontaneous bacterial peritonitis.
- To evaluate the impact of treatments, including albumin, on SBP-related mortality.
Main Methods:
- Retrospective analysis of 29 patients with cirrhotic ascites infection treated between 1996 and 2013.
- Data collected included demographics, paracentesis findings, clinical course, and treatment outcomes.
- Patients were on the deceased-donor liver transplant waiting list.
Main Results:
- The study group comprised 72.4% males, with an average age of 46.6 years.
- Most patients had advanced liver disease (55.2% Child-Pugh C) and a MELD score of 17 ± 4.1.
- Mortality was 81.3% in Child-Pugh C patients; albumin treatment did not significantly affect mortality.
Conclusions:
- Advanced liver disease (Child-Pugh C) is strongly associated with increased SBP mortality.
- Contrary to common clinical belief, albumin treatment did not demonstrate a significant impact on mortality in this patient cohort.
- Chronic renal failure, liver graft surgery, and hepatocellular cancer were not significant mortality predictors in this study.
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