J Korean Med Sci.  2018 Dec;33(52):e335. 10.3346/jkms.2018.33.e335.

Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

• Kim JH
• Choe WH
• Kwon SY
• Yoo BC

• KMID: 2429596
• DOI: http://doi.org/10.3346/jkms.2018.33.e335

Abstract

BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients.
METHODS
This study enrolled patients diagnosed with SBP between 2005 and 2017. Medical records of patients were reviewed and clinical course was compared between the non-HCC and HCC groups.
RESULTS
In total, 123 SBP cases including 49 HCC cases were enrolled. Men were predominant (48/74, 64.9% vs. 34/49, 69.4%; P = 0.697); median age was 58 years in both non-HCC and HCC groups (P = 0.887). The most common etiology was alcohol (32/74, 43.2%) in non-HCC group and hepatitis B (30/49, 61.2%) in HCC group (P = 0.009). Antibiotic resistance rate was higher in non-HCC than in HCC group (29.7% vs. 12.2%; P = 0.028); in-hospital mortality did not differ between the groups (25/74, 33.8% vs. 13/49, 26.5%; P = 0.431). Development rate of hepatorenal syndrome did not differ between non-HCC and HCC group (14/74, 18.9% vs. 10/49, 20.4%; P = 1.000), but hepatic encephalopathy was less common in HCC group (26/74, 35.2% vs. 9/49, 18.3%; P = 0.008). The most important predictor of in-hospital mortality in patients with HCC was white blood cell count above 11,570 cells/mm3 (odds ratio, 6.629; 95% confidence interval, 1.652-26.590; P = 0.008).
CONCLUSION
Prognosis of SBP in HCC patients is relatively less severe. This result may be related with reduced antibiotics resistance and lower development rates of other complications, such as hepatic encephalopathy. Degree of systemic inflammation may be the most important factor for in-hospital mortality.

Keyword

Liver Cirrhosis; Peritonitis; Hepatocellular Carcinoma; In-Hospital Mortality

MeSH Terms

Anti-Bacterial Agents
Carcinoma, Hepatocellular*
Drug Resistance, Microbial
Hepatic Encephalopathy
Hepatitis B
Hepatorenal Syndrome
Hospital Mortality
Humans
Inflammation
Leukocyte Count
Liver Cirrhosis
Male
Medical Records
Peritonitis*
Prognosis*
Anti-Bacterial Agents