title: Spontaneous bacterial peritonitis in patients with hepatitis B-related cirrhosis and hepatocellular carcinoma.
abstract: To delineate the natural clinical course of spontaneous bacterial peritonitis in hepatitis B-related cirrhosis and to determine if it occurs in hepatocellular carcinoma, a prospective survey was conducted in 262 patients over 2 1/2 years. The in-hospital incidence and mortality rates of spontaneous bacterial peritonitis were 21.6% and 36.4%, respectively, in cirrhosis and 7.3% and 50% in hepatocellular carcinoma. In cirrhosis, the cumulative probability of annual recurrence of spontaneous bacterial peritonitis was 47.3%, which was significantly higher than the annual probability of occurrence of 11.3% in those with no previous attack (P less than 0.0001). The cumulative probability of annual survival was 27.6% in the spontaneous bacterial peritonitis patients, significantly lower than the probability of 64.0% in the control group (P = 0.0001). A univariate analysis, with Kaplan-Meier curves compared by the Mantel-Cox test, and subsequent multivariate analysis by stepwise Cox regression procedure were used to evaluate 37 variables recorded immediately after admission. Blood urea nitrogen concentration greater than 10.5 mmol/L urea (greater than 30 mg/dL) and ascitic fluid protein concentration less than 7.35 g/L (less than 735 mg/dL) were found to be the only significant predictors of lower annual survival; ascitic fluid protein concentration less than 7.50 g/L (less than 750 mg/dL) was the only significant predictor of higher annual recurrence. The authors conclude that spontaneous bacterial peritonitis has a high risk of recurrence in hepatitis B-related cirrhosis and that the same disease occurring in patients with hepatocellular carcinoma is related to the underlying cirrhosis rather than the hepatocellular carcinoma.
authors.affiliation: Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
authors.forename: Y T
authors.initials: YT
authors.lastname: Tsai
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
authors.forename: H T
authors.initials: HT
authors.lastname: Chen
authors.forename: C W
authors.initials: CW
authors.lastname: Lu
authors.forename: F Y
authors.initials: FY
authors.lastname: Lee
authors.forename: J S
authors.initials: JS
authors.lastname: Jeng
authors.forename: Y C
authors.initials: YC
authors.lastname: Liu
authors.forename: K J
authors.initials: KJ
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001202:Ascitic Fluid / Q000737:chemistry; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D001806:Blood Urea Nitrogen; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D006514:Hepatitis B Surface Antigens; D011506:Proteins