Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study.
BACKGROUND
Patients with spontaneous bacterial peritonitis (SBP) are at a high risk for renal failure and death despite successful treatment of infection. Intravenous (IV) albumin administration combined with antibiotic treatment has been shown to significantly decrease these risks. Clinical evidence is lacking on which patients are appropriate candidates for albumin treatment.


OBJECTIVE
To retrospectively analyse the usefulness of serum creatinine and bilirubin levels in predicting renal failure and mortality of patients hospitalized for SBP.


METHODS
Between March 1995 and September 1998, 127 cirrhotic patients with SBP who had not received plasma expansion were evaluated. Eighty-one patients (64%) were classified as having a high risk for renal failure and mortality (serum bilirubin >4 mg/dl or serum creatinine >1 mg/dl) and 46 (36%) as having a low risk.


RESULTS
At admission, 36.3% of all patients presented renal failure. Mortality during their hospitalization was 23% among those with a high risk and 6.5% among those with a low risk (P=0.01). Renal failure occurred in 23% of the high-risk patients, compared with 2.6% of the low-risk patients (P=0.006). The presence of hyponatraemia was significantly associated with higher mortality and renal failure in the high-risk group.


CONCLUSIONS
Our retrospective review of patients with SBP suggests that serum bilirubin levels >4 mg and serum creatinine levels >1 mg/dl at the time of diagnosis represent significant risk factors for the clinical outcomes of patients with SBP. Patients without these risk factors may have a very low likelihood of death or renal failure.
Terg
Rubén
R
Hospital de Gastroenterología Dr. Bonorino Udaondo, Universidad del Salvador, Buenos Aires, Argentina. fundhig@speedy.com.ar
Gadano
Adrian
A
Cartier
Mariano
M
Casciato
Paola
P
Lucero
Romina
R
Muñoz
Alberto
A
Romero
Gustavo
G
Levi
Diana
D
Terg
Gonzalo
G
Miguez
Carlos
C
Abecasis
Raquel
R
D000328:Adult; D000368:Aged; D001118:Argentina; D001663:Bilirubin / Q000097:blood*; D003404:Creatinine / Q000097:blood*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology / Q000378:metabolism* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
D003404:Creatinine; D001663:Bilirubin