Spontaneous Bacterial Peritonitis: Is It Still A Life-Threatening Issue in Cirrhosis?

Introduction and aim. Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with cirrhosis. However, it is unknown whether patients with SBP and cirrhosis who do not have active gastrointestinal bleeding have a poorer prognosis if treated with proton pump inhibitors (PPI). Material and methods. We used the Taiwan National Health Insurance Database to identify 858 patients with SBP and cirrhosis who were administered PPIs and hospitalized between January 1, 2010, and December 31, 2013. One-to-two propensity score matching was performed to select a comparison group based on age, gender, and comorbidities. All patients obtained follow-up for 1 year. Results: The overall 30-day, 90-day, and 1-year mortality was 27.9%, 49.0%, and 73.7%, respectively, in the PPI group and 25.6%, 43.8%, and 67.2%, respectively, in the non-PPI group. After adjusting the Cox regression model for age, gender, and comorbidities, the hazard ratios for PPIs regarding 30-day, 30- to 90-day, and 90-day to 1-year mortality were 1.074 (95% CI 0.917-1.257, P = 0.377), 1.390 (95% CI 1.154-1.673, P = 0.001), and 1.297 (95% CI 1.099-1.531, P = 0.002), respectively. Conclusions: PPIs did not increase the short-term mortality of patients with SBP and cirrosis who did not have active gastrointestinal bleeding, but PPIs increased the long-term mortality risk. For these patients, physicians should discontinue PPIs as early as possible.

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Spontaneous Bacterial Peritonitis: An Unusual Life-Threatening Complication of Congestive Heart Failure

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2014.12.015 ◽

2015 ◽

Vol 31 (5) ◽

pp. 691.e13-691.e14 ◽

Cited By ~ 1

Author(s):

John P. Rossiter ◽

Kristopher Cunningham ◽

Paul N. Manley

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Spontaneous Bacterial Peritonitis ◽

Bacterial Peritonitis ◽

Life Threatening ◽

Life Threatening Complication

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Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal Syndrome

10.2310/gastro.5496 ◽

2015 ◽

Author(s):

Fredric D. Gordon

Keyword(s):

Web Sites ◽

Spontaneous Bacterial Peritonitis ◽

Hepatorenal Syndrome ◽

Treatment Options ◽

Screening Tests ◽

Refractory Ascites ◽

Bacterial Peritonitis ◽

Life Threatening ◽

Associated Conditions ◽

Primary Focus

Ascites, a common occurrence in cirrhotic patients with portal hypertension, is the pathologic accumulation of fluid in the peritoneum. Associated conditions are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP occurs in 30% of patients with ascites and carries a 20% mortality, most often due to the severity of the underlying cirrhosis. HRS involves life-threatening sequela of refractory ascites with limited treatment options; a review that focuses exclusively on this disease can be found elsewhere in this section. The development of these diseases is a poor prognostic feature, and referral for liver transplantation should be a consideration. This review examines ascites, SBP, and HRS and their relation to each other. The primary focus is ascites, addressing its epidemiology, pathophysiology, diagnosis, differential diagnosis, and management. Figures show theories of ascites formation and pathophysiology of HPS. Tables list screening tests on ascitic fluid, serum ascites–albumin gradient, drugs and agents to avoid in patients with ascites, diagnostic criteria for HPS, and clinical features of type 1 HPS. Also included are two recommended, pertinent Web sites for those who wish to learn more about ascites, SBP, and HPS. This review contains 2 highly rendered figures, 5 tables, and 73 references.

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Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication?

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s2688 ◽

2008 ◽

Vol Volume 4 ◽

pp. 919-925 ◽

Cited By ~ 10

Author(s):

Tarsila Ribeiro

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Bacterial Peritonitis ◽

Life Threatening

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Gastrointestinal Emergencies

Emergency Medicine ◽

10.1093/med/9780190852955.003.0002 ◽

2019 ◽

pp. 43-70

Author(s):

Sukhjit Dhillon ◽

James McCue ◽

Steven Riccoboni ◽

Caleb Sunde

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Mesenteric Ischemia ◽

Gastrointestinal Disorders ◽

Age And Gender ◽

Duration Of Symptoms ◽

Bacterial Peritonitis ◽

Bilirubin Encephalopathy ◽

Abdominal Aortic ◽

Life Threatening ◽

And Gender

Gastrointestinal disorders and emergencies are one of the most common presentations to an emergency department (ED). Symptoms frequently seen in the ED include abdominal pain, nausea, vomiting, diarrhea, and fever. The differential diagnosis changes depending on the age and gender of the patient, duration of symptoms, the systemic effects, recent travel or exposures, and the description of the symptoms. Life-threatening emergencies include abdominal aortic aneurysm, mesenteric ischemia, foreign body ingestion, gastrointestinal bleeding, acute pancreatitis, spontaneous bacterial peritonitis, aortoenteric fistula, and acute bilirubin encephalopathy, among others. It is the emergency physician’s job to recognize these life-threatening conditions of the gastrointestinal tract and start treatment.

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