Predictors of immediate and short-term mortality in spontaneous bacterial peritonitis
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ORIGINAL ARTICLE
Predictors of immediate and short-term mortality in spontaneous bacterial peritonitis Uday Sanglodkar 1 & Mayank Jain 1 & Jayanthi Venkataraman 1 Received: 31 August 2018 / Accepted: 13 April 2020 # Indian Society of Gastroenterology 2020
Abstract Background There is scarce data from the Indian subcontinent on the outcomes following spontaneous bacterial peritonitis (SBP). Aim To study the immediate (within 30 days) and short-term mortality (31–90 days) associated with SBP and to determine the predictors of the same. Methods This prospective observational study was done among patients with liver cirrhosis who underwent paracentesis. Patient data included age, gender, co-morbidity, cirrhosis-related complications, model of end-stage liver disease (MELD), and ChildTurcotte-Pugh (CTP) scores. SBP was diagnosed based on ascitic fluid polymorphonuclear leukocyte count > 250/mm3 with or without ascitic fluid culture positivity. Results Of the 870 patients with cirrhosis and ascites registered during the study period, 610 fulfilled the criteria for inclusion. Altogether, 122 patients with SBP were identified: 52 (42.6%) died, 40 (32.8%) survived without liver transplant, and 30 (24.6%) underwent liver transplantation within 3 months. Thirty-two patients (26.2%) were blood culture posi tive for bacteria and 7 (5.7%) demonstrable bacterial growth in ascitic fluid. Blood culture positivity was significantly higher in the group with immediate mortality (p < 0.0001) and was also significantly associated (p 0.005) with mortality at 3 months. Conclusion Nearly two-fifths (42.6%) of the study cohort died within 3 months of an episode of SBP. Four-fifths of these patients died within 30 days. Blood culture positivity was significantly associated with immediate and short-term mortality. Keywords Ascites . Cirrhosis . Infection . Liver . Portal hypertension . Child score . Encephalopathy . Varices . Liver transplantation
Introduction Spontaneous bacterial peritonitis (SBP), an important complication of cirrhosis, is considered a marker of end-stage liver disease and an indication for liver transplantation. Its prevalence ranges between 10% and 30% in hospitalized patients [1]. In outpatient clinic, the prevalence of SBP is approximately 3.5% [2], although majority of these patients are asymptomatic. SBP is associated with high mortality with the reported median mortality during the first episode being around 30% [3].
* Mayank Jain [email protected] 1
Department of Gastroenterology, Gleneagles Global Health City, Chennai 600 100, India
The present study was undertaken to evaluate the immediate (within 30 days) and short-term mortality (31–90 days) associated with SBP in Indian setting and to determine the predictors for the same.
Methods This prospective observational study was done at Gleneagles Global Health City, Chennai, between September 2016 and February 2018. The study cohort comprised of patients with confirmed liver cirrhosis (by either radiological imaging or histology) who underwent one or m
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