title: Prevalence and prognostic value of hepatocellular carcinoma in cirrhotic patients presenting with spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  This study examined the prognostic power of hepatocellular carcinoma in patients presenting an episode of spontaneous bacterial peritonitis treated with 3rd generation cephalosporins or quinolones, and subsequent prophylaxis with norfloxacin until death or transplantation.
  
  
  METHODS
  The study comprises the prospective evaluation of 168 consecutive cirrhosis patients presenting an episode of spontaneous bacterial peritonitis.
  
  
  RESULTS
  Hepatocellular carcinoma was diagnosed in 35 out of the 168 (20%) patients included in the study (10 single; 25 advanced tumors). Renal impairment developed in 82 patients. Resolution of infection was achieved in 90% of the cases, the hospital survival being 70%. Renal impairment, advanced tumor stage, albumin, and GGT showed independent prognostic value for hospital mortality. At the end of follow-up 101 patients had died, the 1- and 2-year survival being 36% and 31%, respectively. Four variables independently predicted survival: advanced tumor (OR: 3.9; p=0.00001), renal impairment (OR: 2.1; p=0.00001), bilirubin (OR: 1.6; p=0.02) and creatinine (OR: 1.3; p=0.03). Advanced tumor retained independent predictability in patients surviving hospitalization (OR: 7.5; p=0.0001), the 6-month survival being significantly lower in patients with advanced tumor (12% vs 57%, p<0.00001).
  
  
  CONCLUSIONS
  The prevalence of hepatocellular carcinoma in cirrhotic patients with spontaneous bacterial peritonitis is high, and its presence should be actively sought. Advanced tumor impairs both hospital and long-term survival, and should be considered in the design of future trials.
authors.affiliation: BCLC (Barcelona-Clinic Liver Cancer) Group, Liver Unit, Hospital Clinic i Provincial, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Llovet
authors.forename: E
authors.initials: E
authors.lastname: Moitinho
authors.forename: M
authors.initials: M
authors.lastname: Sala
authors.forename: R
authors.initials: R
authors.lastname: Bataller
authors.forename: P
authors.initials: P
authors.lastname: Rodríguez-Iglesias
authors.forename: A
authors.initials: A
authors.lastname: Castells
authors.forename: J
authors.initials: J
authors.lastname: Fernández
authors.forename: R
authors.initials: R
authors.lastname: Planas
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: J
authors.initials: J
authors.lastname: Bruix
authors.forename: J
authors.initials: J
authors.lastname: Rodés
mesh_terms: D000368:Aged; D001424:Bacterial Infections; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications* / Q000382:microbiology*; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis