Relationship between the degree of portal hypertension and the onset of spontaneous bacterial peritonitis in patients with cirrhosis.
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhosis but its exact pathogenesis has not yet been elucidated and the role of portal hypertension in the development of SBP has been suggested. The aim of this study was to test the hypothesis that an association exists between the degree of portal hypertension and the occurrence of SBP.


METHODS
292 patients with cirrhosis who underwent a measurement of the hepatic venous pressure gradient (HVPG) were retrospectively studied. Following their ascites profile, patients were classified in three groups: patients with ascites who suffered from SBP, patients with sterile ascites, and patients who had no ascites.


RESULTS
Among the 137 patients with ascites, 24 patients suffered from SBP (17.5%). The mean HVPG was significantly different: 20.7 +/- 6.2 mm Hg in the SBP group, 17.5 +/- 5.1 mm Hg in the sterile ascites group and 14.7 +/- 5.6 mm Hg in the group without ascites (p < 0.05). Patients with the most severe portal hypertension (HVPG > or =30 mm Hg) had the highest risk to suffer from SBP (50%). Using the multivariate analysis, only the serum albumin level (p = 0.004) and the HVPG (p = 0.02) were independently correlated with the occurrence of ascites infection.


CONCLUSIONS
This study suggests that in patients with SBP the degree of portal hypertension is greater than in the non infected patients. Ascites infection is independently associated with a low serum albumin level and a high HVPG.
Sersté
Thomas
T
Department of Gastroenterology, ULB Erasme University Hospital, Brussels, Belgium. thomas.serste@skynet.be
Bourgeois
Nadine
N
Lebrec
Didier
D
Evrard
Sylvie
S
Devière
Jacques
J
Le Moine
Olivier
O
D001201:Ascites / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D001424:Bacterial Infections / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D001774:Blood Chemical Analysis; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D017082:Portal Pressure / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors