Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis

Current clinical guidelines for albumin use in decompensated cirrhosis recommend the use of intravenous albumin infusions for management of ascites-related symptoms and paracentesis (removal of ascitic fluid) and for the management of spontaneous bacterial peritonitis (SBP), renal dysfunction and variceal bleeding. Routine albumin use is not recommended for the management of non-SBP infections. The aim of this review is to improve our understanding of the effects of albumin use in cirrhosis by reviewing the currently available and quantifying the effectiveness of intravenous albumin therapy to prevent specific cirrhosis complications, spontaneous bacterial peritonitis (SBP) and renal dysfunction. Long-term albumin administration to patients with decompensated cirrhosis improves survival, prevents complications, eases the management of ascites and reduces hospitalizations, thus being cost-effective. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.

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Tu1726 RIFAXIMIN AS FIRST-LINE THERAPY FOR PRIMARY PROPHYLAXIS OF SPONTANEOUS BACTERIAL PERITONITIS AMONG DECOMPENSATED CIRRHOSIS: NETWORK META-ANALYSIS OF RANDOMISED TRIALS

Gastroenterology ◽

10.1016/s0016-5085(20)34338-9 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1471-S-1472

Author(s):

YU JUN WONG ◽

Yoko Wong ◽

Chin-Hock N. Tee ◽

Huey Ming Johnathan Lum ◽

Tiing Leong Ang ◽

...

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Meta Analysis ◽

Primary Prophylaxis ◽

Decompensated Cirrhosis ◽

Randomised Trials ◽

First Line ◽

Bacterial Peritonitis ◽

First Line Therapy ◽

Line Therapy

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Non-typhoidal salmonella: an unusual cause of spontaneous bacterial peritonitis in decompensated cirrhosis

Gastroenterology Report ◽

10.1093/gastro/gou018 ◽

2014 ◽

Vol 2 (3) ◽

pp. 242-244 ◽

Cited By ~ 2

Author(s):

T. Joseph ◽

P. Sobhan ◽

S. Bahuleyan ◽

A. John ◽

S. Abdul Sathar ◽

...

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Decompensated Cirrhosis ◽

Bacterial Peritonitis

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Cephalosporin resistance in community acquired spontaneous bacterial peritonitis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.17 ◽

2019 ◽

Vol 35 (1) ◽

Cited By ~ 1

Author(s):

Shahid Sarwar ◽

Shandana Tarique ◽

Umaima Waris ◽

Anwaar Ahmad Khan

Keyword(s):

Hospital Mortality ◽

Spontaneous Bacterial Peritonitis ◽

Medical Center ◽

Response Assessment ◽

Early Response ◽

Generation Cephalosporin ◽

Female Ratio ◽

Creative Commons ◽

Bacterial Peritonitis ◽

Cephalosporin Resistance

Objective: To determine 3rd generation cephalosporin resistance in patients with community-acquired spontaneous bacterial peritonitis (SBP) using early response assessment. Methods: This prospective quasi-experimental study was carried out at Doctors Hospital & Medical Center from January 2016 to September 2018. Patients with cirrhosis and SBP were included. Third generation cephalosporins i.e. cefotaxime/ceftriaxone were used for treatment of SBP. Response after 48 hours was assessed and decline in ascitic fluid neutrophil count of < 25% of baseline was labelled as cephalosporin resistant. Carbapenem were used as second line treatment. Recovery and discharge or death of patients were primary end points. Results: Male to female ratio in 31 patients of SBP was 1.2/1 (17/14). Hepato-renal syndrome was diagnosed in 11(37.9%) patients. Cefotaxime was used for 16(51.6%) patients whereas ceftriaxone for 15(48.3%) patients. Early response of SBP was noted in 26(83.8%) patients while 5 (16.2%) were non-responders to cephalosporins. SBP resolved in all non-responding patients with i/v carbapenem. In-hospital mortality was 12.9% and had no association with cephalosporin resistance. High bilirubin (p 0.04), deranged INR (p 0.008), low albumin (p 0.04), high Child Pugh (CTP) score (p 0.03) and MELD scores (p 0.009) were associated with in-hospital mortality. Conclusion: Cephalosporin resistance was present in 16.2% of study patients with community-acquired SBP. Mortality in SBP patients is associated with advanced stage of liver disease. How to cite this:Sarwar S, Tarique S, Waris U, Khan AA. Cephalosporin resistance in community acquired spontaneous bacterial peritonitis. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.17 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Ascitic Interleukin 6 Is Associated with Poor Outcome and Spontaneous Bacterial Peritonitis: A Validation in Critically Ill Patients with Decompensated Cirrhosis

Journal of Clinical Medicine ◽

10.3390/jcm9092865 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2865

Author(s):

Ulrich Mayr ◽

Marina Lukas ◽

Mayada Elnegouly ◽

Christine Vogt ◽

Ulrike Bauer ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Interleukin 6 ◽

Spontaneous Bacterial Peritonitis ◽

Polymorphonuclear Neutrophils ◽

Decompensated Cirrhosis ◽

Diagnostic Ability ◽

Bacterial Peritonitis ◽

Rule Out

Decompensated cirrhosis predisposes to infectious diseases and acute-on-chronic liver failure (ACLF) in critically ill patients. Infections like spontaneous bacterial peritonitis (SBP) are frequently associated with multi-organ failure and increased mortality. Consequently, reliable predictors of outcome and early diagnostic markers of infection are needed to improve individualized therapy. This study evaluates the prognostic role of ascitic interleukin 6 in 64 patients with cirrhosis admitted to our intensive care unit (ICU). In addition, we analysed the diagnostic ability of ascitic interleukin 6 in a subgroup of 19 patients with SBP. Baseline ascitic interleukin 6 performed well in predicting 3-month mortality in patients with decompensated cirrhosis (area under curve (AUC) = 0.802), as well as in patients fulfilling ACLF-criteria (AUC = 0.807). Ascitic interleukin 6 showed a moderate prognostic advantage compared with common clinical scores and proinflammatory parameters. Moreover, ascitic interleukin 6 had a sufficient diagnostic ability to detect SBP (AUC = 0.901) and was well correlated with ascitic polymorphonuclear neutrophils in SBP (p = 0.002). Interestingly, ascitic interleukin 6 revealed a high predictive value to rule out apparent infections on admission to ICU (AUC = 0.904) and to identify patients with “culture-positive SBP” (AUC = 0.856). Ascitic interleukin 6 is an easily-applicable proinflammatory biomarker with high prognostic and diagnostic relevance in critically ill patients with liver cirrhosis.

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