Z Gastroenterol 2013; 51 - A51
DOI: 10.1055/s-0033-1347426

Risk factors for development and mortality of spontaneous bacterial peritonitis in cirrhotic patients with ascites

P Schwabl 1, T Bucsics 1, K Soucek 1, M Mandorfer 1, A Blacky 2, AM Hirschl 2, A Ferlitsch 1, M Trauner 1, M Peck-Radosavljevic 1 T Reiberger 1, Vienna Hepatic Hemodynamic Lab
  • 1Medical University of Vienna/Dept. of Internal Medicine III/Div. of Gastroenterology & Hepatology, Vienna, Austria
  • 2Medical University of Vienna/Dept. of Laboratory Medicine, Div. of Microbiology, Vienna, Austria

Introduction: Ascites is the most common first sign of hepatic decompensation in cirrhotic patients. Risk factors for development of spontaneousbacterial peritonitis (SPB) and subsequent mortality need to be elucidated.

Methodology: Clinical and laboratory parameters of cirrhotic patients undergoing paracentesis at the Medical University of Vienna between 2006 – 2011 were recorded. SBP was defined by a polymorphic nuclear (PMN) cell count > 250/µL. Patients with secondary peritonitis were excluded.

Results: Among 614 cirrhotic patients (57 ± 11 years; 70% male; Child-B:300/Child-C:314; alcoholic:55%, viral:19%) with ascites, 68 (11.1%) developed their first SBP, while 127(20.7%) SBP patients died during the median follow up of 5.6 months (range < 1 month – 7 years). Parameters associated with SBP development were male gender (81% vs. 68%; p < 0.001), higher ascitic fluid PMN count (93 ± 78 vs. 70 ± 64 cells/µL; p = 0.046), longer hospitalization time (23.9 ± 13.3 vs. 15.2 ± 6.3 days; p = 0.037), Child-Pugh C (55.6% vs. 45.1%; p = 0.003), higher MELD (p = 0.042), and CRP (3.05 ± 3.93 vs. 1.91 ± 2.92; p = 0.007). A logistic regression model revealed male sex (OR:2.23; 95% CI: 1.48 – 3.37; p < 0.001), Child-Pugh C (OR:3.17; 95% CI: 2.18 – 4.61; p < 0.001) and ascitic fluid PMN count (per 100 cells/µL; OR:1.39; 95% CI: 1.08 – 1.79; p = 0.01) as independent risk factors for the development of SBP.

One month mortality after SBP was 35.0% and was influenced by age (p = 0.041), Child-Pugh stage (82.8% vs. 47.1%; p < 0.001), MELD score (26.6 ± 9.8 vs. 17.9 ± 7.17; p < 0.001), serum creatinine (2.21 ± 1.25 vs. 1.50 ± 0.99 mg/dL; p < 0.001), white blood cell count (WBC) (9.8 ± 7.1 vs. 6.9 ± 5.4G/L; p = 0.004), CRP (8.83 ± 6.96 vs. 6.69 ± 5.61 mg/dL; p = 0.004), bilirubin (p < 0.001) and INR (p < 0.001) at time of SBP diagnosis. Moreover, development of sepsis (p < 0.001), hepato-renal syndrome (p = 0.001) or hepatic encephalopathy (p = 0.004) were significantly associated with mortality. Multivariate analysis showed age (p = 0.001), MELD score (p < 0.001), and WBC (p = 0.044) as independent risk factors for SBP-related mortality.

Conclusion: This large cohort study identified male sex, Child-Pugh stage C, and higher ascitic fluid PMN count as independent risk factors for SBP development, while age, MELD and WBC were independently associated with mortality.