Risk stratification of spontaneous bacterial peritonitis in cirrhosis with ascites based on classification and regression tree analysis.
Risk stratification for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites helps guide care. Existing prediction models, such as end-stage liver disease (MELD) score, are accurate but controversial in clinical practice. We developed and validated a practical user-friendly bedside tool for SBP risk stratification of patients with cirrhosis and ascites. Using classification and regression tree (CART) analysis, a model was developed for prediction of SBP in cirrhosis with ascites. The CART model was derived on data collected from 676 patients admitted from January 2007 to December 2009 retrospectively, and then was prospectively tested in another independent 198 inpatients between January 2010 and December 2010. The accuracy of CART model was evaluated using the area under the receiver operating characteristic curve. The performance of the model was further validated by comparing its predictive accuracy with that of the MELD score. Furthermore, the model was used to stratify SBP among patients with MELD scores under 15. CART analysis identified four variables for prediction of SBP: creatinine, total bilirubin, prothrombin time and white blood cell count, and three risk groups: low (2.0%), intermediate (27.5-33.3%) and high (60.6-86.4%) risk. The accuracy of CART model (0.881) exceeded that of MELD (0.791). Subjects in the intermediate risk and high risk groups had 22.21-fold (95% confident interval (CI), 9.98-49.45) and 173.50-fold (95% CI, 77.68-634.33) increased risk of SBP, respectively, comparing with the low risk group. Similar results were found when this risk stratification was applied to the validation cohort. Cirrhotic patients with ascites at low, intermediate, and high risk for SBP can be easily identified using CART model, which provides clinicians with a validated, practical bedside tool for SBP risk stratification.
Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical College, No. 2 Fuxue Lane, Wenzhou, 325000, China.
Ke-Qing
KQ
Shi
Yu-Chen
YC
Fan
Li
L
Ying
Xian-Feng
XF
Lin
Mei
M
Song
Ling-Fei
LF
Li
Xie-Yan
XY
Yu
Yong-Ping
YP
Chen
Ming-Hua
MH
Zheng
D001201:Ascites / Q000150:complications* / Q000453:epidemiology; D001424:Bacterial Infections / Q000150:complications* / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D012307:Risk Factors