Persistent spontaneous bacterial peritonitis

A common complication in patients with spontaneous bacterial peritonitis and a high score in the model for end-stage liver disease

Archita Desai, Nancy Reau, K. Gautham Reddy, Helen S. Te, Smruti Mohanty, Rohit Satoskar, Amanda Devoss, Donald Jensen

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: Spontaneous bacterial peritonitis (SBP) is associated with a high mortality rate. After antibiotic therapy, improvement in fluid polymorphonuclear (PMN) cell count is expected within 2 days. However, our institution recognized cases unresponsive to standard treatment. Methods: To study these recalcitrant cases, we completed a retrospective chart review of patients admitted for SBP to the University of Chicago from 2002 to 2007. SBP was defined by an ascitic PMN cell count >250/ml. Results: Of 55 patients with SBP, 15 did not show improvement in fluid PMN cell count to below 250/ml with standard treatment, leading to a prevalence of 27%. The patients with persistent SBP were younger than those with nonpersistent SBP [mean (SD) 51.80 (9.84) compared with 58.13 (8.79); p=0.0253]. Persistent SBP had a higher serum ascites albumin gradient (SAAG) [median (Q1, Q3) 1.85 (1.50, 2.41) compared with 1.10 (0.60, 1.60)] and a higher score in the model for end-stage liver disease (MELD) [mean (SD) 27.98 (8.09) compared with 22.22 (8.10)] than nonpersistent SBP patients; p=0.027 and p=0.023, respectively. In addition, persistent SBP patients were more likely to have a positive ascitic fluid culture than nonpersistent SBP patients [odds ratio (OR) (95% CI) 4.33 (1.21, 15.47); p=0.024]. Importantly, in-hospital mortality in the persistent SBP group was 40%, compared with 22.5% in the nonpersistent SBP group [OR=2.30 (0.64, 8.19); p=0.20]. Conclusions: The risk of persistent SBP is nearly 40% in patients with MELD score >25, SAAG >1.5 or positive ascitic fluid culture. Furthermore, patients who develop persistent SBP tend to experience a higher mortality rate. This study underscores the importance of further examination of this vulnerable population.

Original languageEnglish (US)
Pages (from-to)275-283
Number of pages9
JournalTherapeutic Advances in Gastroenterology
Volume5
Issue number5
DOIs
StatePublished - Sep 2012
Externally publishedYes

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End Stage Liver Disease
Peritonitis
Cell Count
Ascitic Fluid
Ascites
Serum Albumin
Odds Ratio
Mortality
Vulnerable Populations
Hospital Mortality

Keywords

  • ascites
  • cirrhosis
  • model for end-stage liver disease (MELD) score
  • portal hypertension
  • spontaneous bacterial peritonitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Persistent spontaneous bacterial peritonitis : A common complication in patients with spontaneous bacterial peritonitis and a high score in the model for end-stage liver disease. / Desai, Archita; Reau, Nancy; Reddy, K. Gautham; Te, Helen S.; Mohanty, Smruti; Satoskar, Rohit; Devoss, Amanda; Jensen, Donald.

In: Therapeutic Advances in Gastroenterology, Vol. 5, No. 5, 09.2012, p. 275-283.

Research output: Contribution to journalArticle

Desai, Archita ; Reau, Nancy ; Reddy, K. Gautham ; Te, Helen S. ; Mohanty, Smruti ; Satoskar, Rohit ; Devoss, Amanda ; Jensen, Donald. / Persistent spontaneous bacterial peritonitis : A common complication in patients with spontaneous bacterial peritonitis and a high score in the model for end-stage liver disease. In: Therapeutic Advances in Gastroenterology. 2012 ; Vol. 5, No. 5. pp. 275-283.
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abstract = "Objectives: Spontaneous bacterial peritonitis (SBP) is associated with a high mortality rate. After antibiotic therapy, improvement in fluid polymorphonuclear (PMN) cell count is expected within 2 days. However, our institution recognized cases unresponsive to standard treatment. Methods: To study these recalcitrant cases, we completed a retrospective chart review of patients admitted for SBP to the University of Chicago from 2002 to 2007. SBP was defined by an ascitic PMN cell count >250/ml. Results: Of 55 patients with SBP, 15 did not show improvement in fluid PMN cell count to below 250/ml with standard treatment, leading to a prevalence of 27{\%}. The patients with persistent SBP were younger than those with nonpersistent SBP [mean (SD) 51.80 (9.84) compared with 58.13 (8.79); p=0.0253]. Persistent SBP had a higher serum ascites albumin gradient (SAAG) [median (Q1, Q3) 1.85 (1.50, 2.41) compared with 1.10 (0.60, 1.60)] and a higher score in the model for end-stage liver disease (MELD) [mean (SD) 27.98 (8.09) compared with 22.22 (8.10)] than nonpersistent SBP patients; p=0.027 and p=0.023, respectively. In addition, persistent SBP patients were more likely to have a positive ascitic fluid culture than nonpersistent SBP patients [odds ratio (OR) (95{\%} CI) 4.33 (1.21, 15.47); p=0.024]. Importantly, in-hospital mortality in the persistent SBP group was 40{\%}, compared with 22.5{\%} in the nonpersistent SBP group [OR=2.30 (0.64, 8.19); p=0.20]. Conclusions: The risk of persistent SBP is nearly 40{\%} in patients with MELD score >25, SAAG >1.5 or positive ascitic fluid culture. Furthermore, patients who develop persistent SBP tend to experience a higher mortality rate. This study underscores the importance of further examination of this vulnerable population.",
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AU - Reddy, K. Gautham

AU - Te, Helen S.

AU - Mohanty, Smruti

AU - Satoskar, Rohit

AU - Devoss, Amanda

AU - Jensen, Donald

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