title: Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management.
abstract: OBJECTIVE
  Secondary bacterial peritonitis in cirrhotic patients is an uncommon entity that has been little reported. Our aim is to analyse the frequency, clinical characteristics, treatment and prognosis of patients with secondary peritonitis in comparison to those of patients with spontaneous bacterial peritonitis (SBP).
  
  
  METHODS
  Retrospective analysis of 24 cirrhotic patients with secondary peritonitis compared with 106 SBP episodes.
  
  
  RESULTS
  Secondary peritonitis represented 4.5% of all peritonitis in cirrhotic patients. Patients with secondary peritonitis showed a significantly more severe local inflammatory response than patients with SBP. Considering diagnosis of secondary peritonitis, the sensitivity of Runyon's criteria was 66.6% and specificity 89.7%, Runyon's criteria and/or polymicrobial ascitic fluid culture were present in 95.6%, and abdominal computed tomography was diagnostic in 85% of patients in whom diagnosis was confirmed by surgery or autopsy. Mortality during hospitalization was higher in patients with secondary peritonitis than in those with SBP (16/24, 66.6% vs. 28/106, 26.4%) (p<0.001). There was a trend to lower mortality in secondary peritonitis patients who underwent surgery (7/13, 53.8%) than in those who received medical treatment only (9/11, 81.8%) (p=0.21). Considering surgically treated patients, the time between diagnostic paracentesis and surgery was shorter in survivors than in non-survivors (3.2+/-2.4 vs. 7.2+/-6.1 days, p=0.31).
  
  
  CONCLUSIONS
  Secondary peritonitis is an infrequent complication in cirrhotic patients but mortality is high. A low threshold of suspicion on the basis of Runyon's criteria and microbiological data, together with an aggressive approach that includes prompt abdominal computed tomography and early surgical evaluation, could improve prognosis in these patients.
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain. gsoriano@santpau.cat
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.forename: José
authors.initials: J
authors.lastname: Castellote
authors.forename: Cristina
authors.initials: C
authors.lastname: Alvarez
authors.forename: Anna
authors.initials: A
authors.lastname: Girbau
authors.forename: Jordi
authors.initials: J
authors.lastname: Gordillo
authors.forename: Carme
authors.initials: C
authors.lastname: Baliellas
authors.forename: Meritxell
authors.initials: M
authors.lastname: Casas
authors.forename: Carles
authors.initials: C
authors.lastname: Pons
authors.forename: Eva María
authors.initials: EM
authors.lastname: Román
authors.forename: Sandra
authors.initials: S
authors.lastname: Maisterra
authors.forename: Xavier
authors.initials: X
authors.lastname: Xiol
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner
mesh_terms: D000368:Aged; D001202:Ascitic Fluid / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging / Q000382:microbiology*; D010538:Peritonitis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed