Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone.
Spontaneous bacterial peritonitis (SBP) is a frequent infection in cirrhotic patients with ascites, with a poor prognosis. The aims of this study were to determine the long-term survival of cirrhotic patients with SBP treated with ceftriaxone and to identify predictive factors related to survival. We studied 47 first episodes of SBP treated with ceftriaxone with a mean follow-up of 272 days. Nineteen variables were recorded to evaluate their relation to survival. The most frequent organism that caused SBP was Escherichia coli (40%). Spontaneous bacterial peritonitis resolution was achieved in 67% of patients. After resolution, SBP recurrence was observed in 44% of patients. The cumulative probability of survival was 68.1% at 1 month and 30.8% at 6 months. After uni-and multivariate analyses of all cases, SBP resolution ( p = 0.0001) and international normalized ratio (INR) ( p = 0.0057) were found to be related to survival. Another analysis performed after SBP resolution and SBP recurrence showed that ascitic fluid-positive culture ( p = 0.0344) and INR ( p = 0.0218) had statistical significance as variables predictive of long-term survival. We conclude that the survival of cirrhotic patients is very short after the first episode of SBP, a fact probably related to advanced liver disease, as liver dysfunction (INR) is the most important factor related to long-term patient survival.
França
A V
AV
Hepatology Unit, Department of Medicine, University of Campinas, Brazil. avcfranca@hotmail.com
De Souza
J B
JB
Silva
C M
CM
Soares
E C
EC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D002443:Ceftriaxone / Q000627:therapeutic use*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D011336:Probability; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D002443:Ceftriaxone