Bacteremia is a prognostic factor for poor outcome in spontaneous bacterial peritonitis.
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.
Cho
Jae Hyun
JH
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Park
Kyung Hwa
KH
Kim
Sung Han
SH
Bang
Ji Hwan
JH
Park
Wan Beom
WB
Kim
Hong-Bin
HB
Kim
Nam Joong
NJ
Oh
Myong-Don
MD
Lee
Hyo Suk
HS
Choe
Kang-Won
KW
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
D015415:Biomarkers