title: Bacteremia is a prognostic factor for poor outcome in spontaneous bacterial peritonitis.
abstract: We performed a retrospective study to determine the influence of bacteremia on the mortality of patients with spontaneous bacterial peritonitis (SBP), a major complication of liver cirrhosis. Patients with SBP with identified pathogens from ascites and/or blood were analyzed by retrospective review of clinical and laboratory records in a university hospital in Korea for 3 y and classified into the bacteremic and non-bacteremic groups. The underlying liver function was determined by model for end-stage liver disease (MELD) score. Microbiological response rate, ascites polymorphonuclear leukocyte (PML) count reduction rate, and SBP-related mortality were compared between the 2 groups. To identify the independent risk factors of mortality, a multiple logistic regression model was used to control for the confounders. A total of 189 patients was enrolled in the study. Among 189 patients, 110 (58.2%) were bacteremic, and 79 (41.8%) non-bacteremic. Escherichia coli was the most common etiologic organism, followed by Klebsiella pneumoniae. MELD scores, microbiological response rate (82.6% vs 88.6%, p=0.295), and ascites PML count reduction rate (33.2% vs 44.8%, p=0.479) were not different between the bacteremic and non-bacteremic group. However, the SBP-related mortality rate of the bacteremic group was significantly higher than that of the non-bacteremic group (37.3% vs 12.7%, p<0.001). Bacteremia (OR=2.86: 95% CI 1.06-7.74, p=0.038), APACHE II score (OR=1.20: 95% CI 1.10-1.31, p<0.001), MELD score (OR=1.07: 95% CI 1.01-1.31, p=0.016) and microbiological no response (OR=5.51: 95% CI 1.82-16.72, p=0.003) were independent risk factors of SBP-related mortality.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Cho
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Park
authors.forename: Sung Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Ji Hwan
authors.initials: JH
authors.lastname: Bang
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: Kim
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Myong-Don
authors.initials: MD
authors.lastname: Oh
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Lee
authors.forename: Kang-Won
authors.initials: KW
authors.lastname: Choe
mesh_terms: D018806:APACHE; D000368:Aged; D001201:Ascites / Q000382:microbiology*; D016470:Bacteremia; D015415:Biomarkers; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D016017:Odds Ratio; D010538:Peritonitis / Q000382:microbiology* / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers