Renal impairment after spontaneous bacterial peritonitis: incidence and prognosis.
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is an important complication in cirrhotic patients. The aim of the present study was to assess the incidence, predictive factors and prognosis for renal impairment (RI) after SBP in cirrhotic patients from southern Brazil.


METHODS
Of the 1030 hospitalizations evaluated, 114 episodes of SBP were diagnosed in 94 patients (mean age 49 years; 76.59% men). SBP diagnosis was established when the ascitic fluid polymorphonuclear cell count was equal to or greater than 250 cells/mm3. Five cases were excluded. The variables assessed as possible predictors of steady or progressive RI were blood urea nitrogen and creatinine levels before the diagnosis of SBP; type of infection, antibiotic prophylaxis, first episode or recurrent SBP, presence of gastrointestinal bleeding and hepatic encephalopathy during hospitalization, SBP resolution, Child-Pugh classification, levels of blood pressure, ascitic fluid and blood polymorphonuclear cell count, bacteriological data (positive and negative ascitic fluid culture), albumin, bilirubin, sodium and prothrombin time at the moment of diagnosis.


RESULTS
The incidence of SBP was 11.07%. In 61 (55.96%) episodes, SBP was associated with RI (transient in 57.37%; steady in 19.67%; and progressive in 22.95%). The mortality rate associated with progressive RI was 100%; 58.33% with steady RI; and 2.85% with transient RI. The mortality rate in patients with or without RI was 36.07% and 6.25%, respectively (P<0.001). The level of creatinine (greater than or equal to 1.3mg/dL) before the diagnosis of SBP and the rate of infection resolution were the only predictors of RI in the multivariate analysis.


CONCLUSIONS
RI after SBP is a common complication, and indicates a poor prognosis for this infection. High levels of creatinine before infection and the rate of infection resolution are independent predictors of RI.
Perdomo Coral
Gabriela
G
Graduate Program in Internal Medicine: Hepatology, Fundação Faculdade de Ciências Médicas de Porto Alegre, Irmandade Santa Casa de Misericórdia de Porto Alegre, Brazil. g.coral@terra.com.br
Alves de Mattos
Angelo
A
D000208:Acute Disease; D000328:Adult; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate