title: Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  Spontaneous bacterial peritonitis (SBP) is associated with high mortality. Early paracentesis (EP) is essential for rapid diagnosis and optimal treatment. The aim of the study is to compare the outcomes of patients with SBP who received EP vs. delayed paracentesis (DP).
  
  
  METHODS
  Consecutive patients who were diagnosed with SBP (ascites neutrophil count ≥250 cells/mm(3) and clinical evidence of cirrhosis) <72 h from the first physician encounter at two centers were identified. EP was defined by receiving paracentesis <12 h and DP 12-72 h from hospitalization. Primary outcome was in-hospital mortality.
  
  
  RESULTS
  The mean age of 239 patients with SBP was 53±10 years; mean Model for End-Stage Liver Disease (MELD) score was 22±9. In all, 98 (41%) patients who received DP had a higher in-hospital mortality (27% vs. 13%, P=0.007) compared with 141 (59%) who received EP. Furthermore, DP group had longer intensive care days (4.0±9.5 vs. 1.3±4.1, P=0.008), hospital days (13.0±14.7 vs. 8.4±7.4, P=0.005), and higher 3-month mortality (28/76, 37% vs. 21/98, 21%; P=0.03) compared with the EP group. Adjusting for MELD score ≥22 (adjusted odds ratio (AOR)=5.7, 95% confidence interval (CI)=1.8-18.5) and creatinine levels ≥1.5 mg/dl (AOR=3.2, 95% CI=1.4-7.2), DP was associated with increased in-hospital mortality (AOR=2.7, 95% CI=1.3-4.8). Each hour delay in paracentesis was associated with a 3.3% (95% CI=1.3-5.4%) increase in in-hospital mortality after adjusting for MELD score and creatinine levels.
  
  
  CONCLUSIONS
  Hospitalized patients with SBP who received DP had a 2.7-fold increased risk of mortality adjusting for MELD score and renal dysfunction. Diagnostic paracentesis performed <12 h from hospitalization in patients with cirrhosis and ascites may improve short-term survival.
authors.affiliation: 1] Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China [2] Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Tsukamoto
authors.affiliation: Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Mathur
authors.affiliation: Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: Yashar M
authors.initials: YM
authors.lastname: Ghomri
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Hou
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sheibani
authors.affiliation: David David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Runyon
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000166:cytology; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D003404:Creatinine / Q000097:blood; D003422:Critical Care / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000401:mortality*; D042241:Early Diagnosis; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D019152:Paracentesis; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality*; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine