scholarly journals Current Management of the Complications of Cirrhosis and Portal Hypertension: Variceal Hemorrhage, Ascites, and Spontaneous Bacterial Peritonitis

2016 ◽  
Vol 34 (4) ◽  
pp. 382-386 ◽  
Author(s):  
Guadalupe Garcia-Tsao
Keyword(s):  
Antibiotic Prophylaxis ◽  
Bacterial Infections ◽  
Spontaneous Bacterial Peritonitis ◽  
Kidney Injury ◽  
Multidrug Resistant ◽  
Variceal Hemorrhage ◽  
Volume Depletion ◽  
Suspected Infection ◽  
Bacterial Peritonitis ◽  
Complications Of Cirrhosis

Cirrhosis is not a single entity but represents a disease progression across different prognostic stages, with the compensated and decompensated stages being the most important. Variceal hemorrhage (VH) and ascites are complications of cirrhosis that denote the presence of a decompensated stage. Spontaneous bacterial peritonitis (SBP) is a common bacterial infection unique to patients with cirrhosis that can precipitate the development of recurrent VH and hepatorenal syndrome (HRS), complications that denote the presence of a ‘further decompensated' stage of cirrhosis. Main current issues in the management of VH include identification of different prognostic stages that allow for individualized patient care. Management of VH cannot be performed in an isolated manner, and the presence of other complications of cirrhosis (ascites, encephalopathy) should be taken into account both in the management and in the design of clinical trials. Because management of ascites per se has not resulted in significant changes in mortality, main management issues consist of preventing further decompensating events by preventing factors that will lead to worsening vasodilatation and hemodynamic status (infections, vasodilators), preventing volume depletion (overdiuresis, GI hemorrhage) and preventing structural kidney injury (nephrotoxins). Prophylaxis of bacterial infections such as SBP currently consists of the administration of antibiotics. By preventing infections, there is evidence that recurrent VH and HRS can also be prevented. However, response to recommended empirical antibiotics in patients with suspected infection, such as SBP, is currently significantly lower than in the past because of an increase in infections secondary to multidrug resistant (MDR) organisms. One of the main predictors of the development of MDR organisms is antibiotic prophylaxis and unnecessary and prolonged use of antibiotics in hospital. Therefore, appropriate antibiotics should be used in patients with a high suspicion of infection, and antibiotic prophylaxis should be restricted to patients with the highest risk of infection.

scholarly journals Albumin: Indications in chronic liver disease

2020 ◽  
Vol 8 (5) ◽  
pp. 528-535 ◽  
Author(s):  
Manuel Tufoni ◽  
Giacomo Zaccherini ◽  
Paolo Caraceni ◽  
Mauro Bernardi
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Cost Effective ◽  
Decompensated Cirrhosis ◽  
Plasma Expander ◽  
Bacterial Peritonitis ◽  
Good Safety Profile ◽  
Complications Of Cirrhosis

Albumin is currently employed as a plasma expander to prevent and treat specific complications of cirrhosis with ascites, such as the prevention of paracentesis-induced circulatory dysfunction and renal dysfunction induced by spontaneous bacterial peritonitis, as well as the diagnosis and treatment of acute kidney injury and hepatorenal syndrome. Recently, evidence has shown that long-term albumin administration in patients with decompensated cirrhosis reduces mortality and incidence of complications, eases the management of ascites, is cost effective, and has a good safety profile.

Quinolone and Multidrug Resistance Predicts Failure of Antibiotic Prophylaxis of Spontaneous Bacterial Peritonitis

2019 ◽  
Vol 70 (9) ◽  
pp. 1916-1924 ◽  
Author(s):  
Marcus M Mücke ◽  
Amelie Mayer ◽  
Johanna Kessel ◽  
Victoria T Mücke ◽  
Dimitra Bon ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Spontaneous Bacterial Peritonitis ◽  
De Novo ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Subdistribution Hazard ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Secondary Infections

Abstract Background The efficacy of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) in patients colonized with multidrug-resistant organisms (MDROs) is unknown. We evaluated the effectiveness of fluoroquinolone-based SBP prophylaxis in an era and area of frequent antibiotic resistance. Methods This is a prospective observational study in patients with liver cirrhosis and an indication for fluoroquinolone-based prophylaxis of SBP. Patients were recruited and followed in a large German tertiary reference center with comprehensive microbiological and clinical monitoring performed at baseline and after 30, 60, 90, and 180 days of prophylaxis. Results Overall, 77 patients received antibiotic prophylaxis for an average of 93 days. Baseline prevalence of colonization with MDROs was high (N = 39, 50.6%). At least one de novo MDRO was detected in 27 patients (35.1%) during antibiotic prophylaxis; 33 patients (42.9%) developed secondary infections, including 14 cases (17.9%) of infections with MDROs, and 13 cases (16.9%) of de novo/recurrent SBP. Thirty patients (39.0%) died during follow-up. Significantly higher risks of SBP development during antibiotic prophylaxis were observed for patients with versus without any apparent MDROs (P = .009), vancomycin-resistant enterococci (P = .008), multidrug-resistant gram-negative bacteria (P = .016), or quinolone-resistant gram-negative bacteria (QR-GNB) (P = .015). In competing risk analysis, QR-GNB were independently associated with prophylaxis failure (hazard ratio, 3.39; P = .045) and infections with QR-GNB were independently associated with death before SBP (subdistribution hazard risk, 6.47; P = .034). Conclusions Antibiotic prophylaxis of SBP appears to be less efficient in patients with known MDROs. Regular MDRO screening seems to be useful to tailor treatment of secondary infections and re-evaluate antibiotic prophylaxis in case of selection of quinolone resistance.

Albumin Utilization in Spontaneous Bacterial Peritonitis

2021 ◽  
pp. 089719002199700
Author(s):  
Alex M. Ebied ◽  
Thakul Rattanasuwan ◽  
Yiqing Chen ◽  
Adonice P. Khoury
Keyword(s):  
High Risk ◽  
Spontaneous Bacterial Peritonitis ◽  
Total Bilirubin ◽  
Kidney Injury ◽  
Inclusion Criteria ◽  
Dosing Regimen ◽  
Bacterial Peritonitis ◽  
Risk Patients ◽  
The Impact ◽  
Order Set

Background: Albumin has been shown to decrease the incidence of mortality and acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP). Albumin administration in SBP is recommended within 6 hours of diagnosis and for reserved use in high-risk patients with the following baseline laboratory tests: serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL or total bilirubin >4 mg/dL. Objective: We aimed to assess the impact of an albumin order set restricted to high-risk SBP. Methods: A retrospective cohort study was conducted between Jan 1, 2013 to Feb 28, 2018. The albumin order set was implemented on Sep 20, 2016. Patients were included if they were diagnosed with SBP and had an ascitic fluid polymorphonuclear count ≥ 250 cells/mm3. Results: Out of a total of 137 patients reviewed, 88 met the inclusion criteria. The incidence of AKI in the pre-order set and post-order set were 63.93% and 33.33% (p = 0.01), respectively. The incidence of mortality in the pre-order set and post-order set were 36.07% and 7.41% (p = 0.005), respectively. The percentage of patients administered albumin within 6 hours were 24.59% to 40.74% (p = 0.14) in the pre-order set and post-order set, respectively. The percentage of patients who received the recommended albumin dosing regimen ordered was 42.62% vs 96.30% (p < 0.001), in the pre-order set and post-order set, respectively. Conclusion: The albumin order set restricted to high-risk SBP patients significantly reduced the incidence of AKI and mortality, and improved the appropriateness of albumin regimen ordered.

Complications of cirrhosis and portal hypertension

2013 ◽  
pp. 251-256 ◽  
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Spontaneous Bacterial Peritonitis ◽  
Early Stage ◽  
Nodule Formation ◽  
Architectural Distortion ◽  
Bacterial Peritonitis ◽  
Complications Of Cirrhosis

Causes and diagnosis of cirrhosis Causes and diagnosis of non-cirrhotic portal hypertension Ascites Spontaneous bacterial peritonitis Hepatorenal syndrome Variceal haemorrhage Hepatic encephalopathy Hepatopulmonary syndromes Hepatocellular carcinoma Cirrhosis occurs following progressive hepatic fibrosis, with architectural distortion of the liver and nodule formation. It is a histological diagnosis. Late-stage cirrhosis is irreversible, at which point only liver transplantation is curative. Early-stage cirrhosis has been shown to improve following treatment and may be asymptomatic....

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