Spontaneous bacterial peritonitis mortality trends of cirrhotic patients in the last decade in Constanta County

Popoiag,Roxana-Emanuela; Panaitescu,Eugenia; Suceveanu,Andra-Iulia; Suceveanu,Adrian-Paul; Micu,Sergiu Ioan; Mazilu,Laura; Parepa,Irinel; Voinea,Felix; Costea,Daniel Ovidiu; Enache,Florin; Fierbințeanu-Braticevici,Carmen

doi:10.3892/etm.2021.10164

Spontaneous bacterial peritonitis mortality trends of cirrhotic patients in the last decade in Constanta County

Authors:
- Roxana-Emanuela Popoiag
- Eugenia Panaitescu
- Andra-Iulia Suceveanu
- Adrian-Paul Suceveanu
- Sergiu Ioan Micu
- Laura Mazilu
- Irinel Parepa
- Felix Voinea
- Daniel Ovidiu Costea
- Florin Enache
- Carmen Fierbințeanu-Braticevici
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Affiliations: Department of Internal Medicine ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Informatics and Biostatistics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, Department of Internal Medicine, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Oncology, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Cardiology, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Urology, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Surgery, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Pediatric Surgery, Emergency Hospital, ‘Ovidius’ University, Faculty of Medicine, 900527 Constanta, Romania, Department of Gastroenterology, University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
Published online on: May 7, 2021 https://doi.org/10.3892/etm.2021.10164
Article Number: 732
Copyright: © Popoiag et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Spontaneous bacterial peritonitis (SBP) is a complication of liver cirrhosis with an increased in‑hospital mortality rate. For this reason, the aim of the present study was to examine the main predictors of mortality in order to be able to identify high‑risk patients in time and to guide the optimal treatment for prognosis improvement. We retrospectively collected demographic, clinical, laboratory and treatment data as well as data regarding length of stay and cost of hospitalization from 72 patients diagnosed with SBP between January 2010 and December 2019 in the Emergency Clinical Hospital St. Apostle Andrew, Constanta, Romania. Patients were divided into two groups: Those who survived and those who died. Logistic regression was used to identify a possible association between these factors and the increased risk of mortality. Univariate analysis revealed that clinical factors (fever, chills, and hepatic encephalopathy), biological factors such as serum and ascites leukocyte value, polymorphonuclear percentage (PMN), erythrocyte sedimentation rate (ESR) value, previous SBP episodes, and the presence of complications such as acute kidney injury (AKI), sepsis, and systemic inflammatory response syndrome (SIRS) were significantly associated with in‑hospital mortality in patients with SBP. Multivariate analysis revealed that SIRS (P=0.0010) and fever (P=0.0258) were significantly associated with in‑hospital mortality in patients with SBP. Findings of the present study suggest that, SIRS and fever were independent predictive factors of mortality in cirrhotic patients with SBP.

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1	La Vecchia C, Levi F, Lucchini F, Franceschi S and Negri E: Worldwide patterns and trends in mortality from liver cirrhosis, 1955 to 1990. Ann Epidemiol. 4:480–486. 1994.PubMed/NCBI View Article : Google Scholar
2	Bosetti C, Levi F, Lucchini F, Witold AZ, Negri E and La Vecchia C: Worldwide mortality from cirrhosis: An update to 2002. J Hepatol. 46:827–839. 2007.PubMed/NCBI View Article : Google Scholar
3	Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L and Sheron N: EASL HEPAHEALTH Steering Committeey. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 69:718–735. 2018.PubMed/NCBI View Article : Google Scholar
4	Garcia-Tsao G: Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. 120:726–748. 2001.PubMed/NCBI View Article : Google Scholar
5	Rimola A, García-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B and Inadomi JM: Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: A consensus document. J Hepatol. 32:142–153. 2000.PubMed/NCBI View Article : Google Scholar
6	European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 53:397–417. 2010.PubMed/NCBI View Article : Google Scholar
7	Tandon P and Garcia-Tsao G: Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 9:260–265. 2011.PubMed/NCBI View Article : Google Scholar
8	Jun BG, Lee WC, Jang JY, Jang JY, Jeong SW, Kim YD, Cheon GJ, Lee YN, Kim SG, Cho YS, et al: Follow-up creatinine level is an important predictive factor of in-hospital mortality in cirrhotic patients with spontaneous bacterial peritonitis. J Korean Med Sci. 33(e99)2018.PubMed/NCBI View Article : Google Scholar
9	Jain M, Sanglodkar U and Venkataraman J: Risk factors predicting nosocomial, healthcare-associated and community-acquired infection in spontaneous bacterial peritonitis and survival outcome. Clin Exp Hepatol. 5:133–139. 2019.PubMed/NCBI View Article : Google Scholar
10	Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG and Levin A: Acute Kidney Injury Network. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11(R31)2007.PubMed/NCBI View Article : Google Scholar
11	Wong F, Bernardi M, Balk R, Christman B, Moreau R, Garsia-Tsao G, Patch D, Soriano G, Hoefs J and Navasa M: International Ascites Club. Sepsis in cirrhosis: Report on the 7th meeting of the International Ascites Club. Gut. 54:718–725. 2005.PubMed/NCBI View Article : Google Scholar
12	Poca M, Alvarado E, Conceptión M, Pérez-Cameo C, Cañete N, Gich I, Romero C, Casas M, Román E, Castells L, et al: P0190: Predictive model of mortality in cirrhotic patients with high risk spontaneous bacterial peritonitis. J Hepatol. 62 (Suppl 2)(S375)2015.
13	Niu B, Kim B, Limketkai BN, Sun J, Li Z, Woreta T and Chen PH: Mortality from spontaneous bacterial peritonitis among hospitalized patients in the USA. Dig Dis Sci. 63:1327–1333. 2018.PubMed/NCBI View Article : Google Scholar
14	Bal CK, Daman R and Bhatia V: Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol. 8:566–572. 2016.PubMed/NCBI View Article : Google Scholar
15	Alexopoulou A, Papadopoulos N, Eliopoulos DG, Alexaki A, Tsiriga A, Toutouza M and Pectasides D: Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis. Liver Int. 33:975–81. 2013.PubMed/NCBI View Article : Google Scholar
16	Campillo B, Richardet JP, Kheo T and Dupeyron C: Nosocomial spontaneous bacterial peritonitis and bacteremia in cirrhotic patients: Impact of isolate type on prognosis and characteristics of infection. Clin Infect Dis. 35:1–10. 2002.PubMed/NCBI View Article : Google Scholar
17	Tsung PC, Ryu SH, Cha IH, Cho HW, Kim JN, Kim YS and Moon JS: Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. Clin Mol Hepatol. 19:131–139. 2013.PubMed/NCBI View Article : Google Scholar
18	Thuluvath PJ, Morss S and Thompson R: Spontaneous bacterial peritonitis-in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 96:1232–1236. 2001.PubMed/NCBI View Article : Google Scholar
19	Mallet V, Gilgenkrantz H, Serpaggi J, Verkarre V, Valle-Pichard A, Fontaine H and Pol S: Brief communication: The relationship of regression of cirrhosis to outcome in chronic hepatitis C. Ann Intern Med. 149:399–403. 2008.PubMed/NCBI View Article : Google Scholar
20	Rodrigues-Pinto E and Freitas-Silva M: Hepatorenal syndrome, septic shock and renal failure as mortality predictors in patients with spontaneous bacterial peritonitis. GE Jornal Português de Gastrenterologia. 19:278–283. 2012.