Gut Liver.
2009 Sep;3(3):197-204.
Clinical Features and Prognosis of Spontaneous Bacterial Peritonitis in Korean Patients with Liver Cirrhosis: A Multicenter Retrospective Study
- Affiliations
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- 1Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.
- 2Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. umsh@korea.ac.kr, drseo@korea.ac.kr
- 3Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
- 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 5Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
- 6Department of Internal Medicine, onsei University Wonju College of Medicine, Wonju, Korea.
- 7Department of Internal Medicine, Sungkyunkwan University College of Medicine, Kangbuk Samsung Hospital, Korea.
- 8Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract
- BACKGROUND/AIMS
Although early recognition and treatment with effective antibiotics have lead to improvements in the prognosis of patients with spontaneous bacterial peritonitis (SBP), it remains to be a serious complication in cirrhotic patients. This study was designed to evaluate the clinical manifestations and prognosis of patients with liver cirrhosis and SBP in Korea.
METHODS
This was a multicenter retrospective study examining 157 episodes of SBP in 145 patients with cirrhosis. SBP was diagnosed based on a polymorphonuclear cell count in ascitic fluid of >250 cells/mm3 in the absence of data compatible with secondary peritonitis.
RESULTS
The mean age of the cohort was 56 years, and 121 (77%) of the 157 episodes of SBP occurred in men. Microorganisms were isolated in 66 episodes (42%): Gram-negative bacteria in 54 (81.8%), Gram-positive in 11 (16.7%), and Candida in 1. Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 6 cases (17%), to ciprofloxacin in 11 (20.8%), and to penicillin in 33 (62.3%). The treatment failure and in-hospital mortality rates were 12.1% and 21%, respectively. A high Model of End-Stage Liver Disease (MELD) score, SBP caused by extended-spectrum beta-lactamase-producing organisms, and hepatocellular carcinoma were independent prognostic factors of high in-hospital mortality.
CONCLUSIONS
SBP remains to be a serious complication with high in-hospital mortality, especially in patients with a high MELD score.
Keyword
MeSH Terms
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Anti-Bacterial Agents
Ascitic Fluid
Candida
Carcinoma, Hepatocellular
Cell Count
Ciprofloxacin
Cohort Studies
Fibrosis
Gram-Negative Bacteria
Hospital Mortality
Humans
Liver
Liver Cirrhosis
Liver Diseases
Male
Penicillins
Peritonitis
Prognosis
Retrospective Studies
Treatment Failure
Anti-Bacterial Agents
Ciprofloxacin
Penicillins
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