Outcomes in Patients with Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis

Jasmohan S. Bajaj, Puneeta Tandon, Jacqueline G. O'Leary, Florence Wong, Scott W. Biggins, Guadalupe Garcia-Tsao, Patrick S. Kamath, Benedict Maliakkal, Michael B. Fallon, Jennifer C. Lai, Paul J. Thuluvath, Hugo E. Vargas, Ram M. Subramanian, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

OBJECTIVES:Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis.METHODS:Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin.RESULTS:Among the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients.DISCUSSION:In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.

Original languageEnglish (US)
Pages (from-to)599-606
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume114
Issue number4
DOIs
StatePublished - Apr 1 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Bajaj, J. S., Tandon, P., O'Leary, J. G., Wong, F., Biggins, S. W., Garcia-Tsao, G., Kamath, P. S., Maliakkal, B., Fallon, M. B., Lai, J. C., Thuluvath, P. J., Vargas, H. E., Subramanian, R. M., Thacker, L. R., & Reddy, K. R. (2019). Outcomes in Patients with Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis. American Journal of Gastroenterology, 114(4), 599-606. https://doi.org/10.14309/ajg.0000000000000044