[Spontaneous bacterial peritonitis: diagnostic and prognostic aspects]

Area of Science:

• Hepatology
• Infectious Diseases
• Gastroenterology

Context:

• Spontaneous bacterial peritonitis (SBP) is a frequent, often subclinical, complication in patients with cirrhosis and ascites.
• Diagnostic challenges arise due to non-specific or absent clinical symptoms in severely ill patients.
• High mortality rates associated with advanced liver disease underscore the need for timely diagnosis and management.

Purpose:

• To investigate the diagnostic and prognostic aspects of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites.
• To evaluate the clinical presentation, microbiological findings, and mortality rates associated with SBP episodes.
• To identify factors influencing prognosis in SBP patients.

Summary:

• This study analyzed 26 SBP episodes in 25 cirrhotic patients, establishing microbiological diagnosis in 18 cases.
• Common pathogens included E. coli and Str. pneumoniae; however, 8 episodes were presumed based on elevated ascitic fluid polymorphonuclear leukocyte (PMN) counts.
• In-hospital mortality was 61% for microbiologically proven SBP versus 14% for culture-negative cases, with 6-month mortality rates of 78% and 86%, respectively.

Impact:

• Prognosis is significantly worse for Child grade C patients, those lacking peritoneal irritation signs, experiencing septic shock, or with elevated serum creatinine.
• The findings highlight SBP as a treatable yet high-mortality complication of advanced liver disease.
• Diagnostic paracentesis is recommended for all cirrhosis patients with ascites experiencing rapid clinical deterioration.