Clin Mol Hepatol.  2013 Jun;19(2):131-139. 10.3350/cmh.2013.19.2.131.

Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis

• Tsung PC
• Ryu SH
• Cha IH
• Cho HW
• Kim JN
• Kim YS
• Moon JS

• KMID: 1776800
• DOI: http://doi.org/10.3350/cmh.2013.19.2.131

Abstract

BACKGROUND/AIMS
Spontaneous bacterial peritonitis (SBP) has been known to greatly influence the survival rate of patients with liver cirrhosis. However, the factors that affect the survival rate in patients with SBP need to be clarified.
METHODS
This study enrolled 95 liver cirrhosis patients diagnosed with SBP. The laboratory findings of their serum and ascitic fluid were examined and the characteristics of the isolated microorganisms in their peritoneal fluid were analyzed.
RESULTS
The proportion of patients with culture-positive SBP was 41.1%, and 47 microorganisms were isolated from the ascitic fluid. The proportions of cultured bacteria that were Gram negative and Gram positive were 57.4% and 40.4%, respectively. The proportions of Escherichia coli, Klebsiella species, and Streptococcus species were 25.5%, 19.1%, and 19.1%, respectively. Enterococcus species represented 12.8% of the microorganisms cultured. The overall survival rates at 6, 12, and 24 months were 44.5%, 37.4%, and 32.2%, respectively. There was no relationship between the bacterial factors and the survival rate in SBP. Multivariate analysis revealed that the presence of hepatocellular carcinoma (HCC; P=0.001), higher serum bilirubin levels (> or =3 mg/dL, P=0.002), a prolonged serum prothrombin time (i.e., international normalized ratio >2.3, P<0.001), renal dysfunction (creatinine >1.3 mg/dL, P<0.001), and lower glucose levels in the ascitic fluid (<50 mg/dL, P<0.001) were independent predictive factors of overall survival rate.
CONCLUSIONS
HCC, higher serum bilirubin levels, a prolonged serum prothrombin time, renal dysfunction, and lower ascitic glucose levels are associated with higher mortality rates in cirrhotic patients with SBP.

Keyword

Liver cirrhosis; Peritonitis; Bacteria; Mortality; Risk factors

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Ascitic Fluid/metabolism/microbiology
Bilirubin/blood
Carcinoma, Hepatocellular/complications/diagnosis
Creatinine/blood
Female
Glucose/analysis
Gram-Negative Bacteria/isolation & purification
Gram-Positive Bacteria/isolation & purification
Humans
Liver Cirrhosis/complications/*mortality
Liver Neoplasms/complications/diagnosis
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Peritonitis/complications/*diagnosis/drug therapy
Prognosis
Prothrombin Time
Survival Rate
Anti-Bacterial Agents
Creatinine
Glucose
Bilirubin