title: Long-term outcomes after hospitalization with spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  To assess the determinants of long-term outcome in patients with spontaneous bacterial peritonitis (SBP).
  
  
  METHODS
  This study was conducted retrospectively. Kaplan-Meier (KM) and Cox proportional hazards survival analyses were performed.
  
  
  RESULTS
  Altogether, 93 patients with SBP were identified, with their mean age of 57.9 ± 12.9 years, Child-Pugh score 10.4 ± 1.9 and model for end-stage liver disease (MELD) score 20.2 ± 6.8. The etiology of chronic liver disease (CLD) was alcohol-related liver disease (ARLD) (n = 58) and viral hepatitis/non-alcoholic steatohepatitis (n = 28). SBP was the index presentation of cirrhosis in 26 (28.0%) patients. Overall mortality was 80.6%; among them 81.3% were liver-related, and 33 (35.5%) died during index hospitalization. In total, 70.0% of patients who survived index hospitalization died during follow-up, with a median survival of 12.5 months. Estimated survival at 3 months, 1 year and 5 years was 54.8%, 34.4% and 15.2%, respectively. Non-ARLD etiology for CLD was an independent predictor of overall mortality (HR 3.484, 95% CI 1.802-6.757, P < 0.001) and mortality in those surviving hospitalization (HR 2.319, 95% CI 1.210-4.444, P = 0.011). Hepatorenal syndrome did not predict outcomes. Two (3.3%) patients surviving hospitalization underwent liver transplantation (LT).
  
  
  CONCLUSIONS
  One-year survival after hospitalization with SBP remains poor (34.4%) with unacceptably low LT rates. Non-ARLD etiology for CLD is an independent predictor of both overall mortality and mortality after discharge. In view of the projected increase in non-alcoholic steatohepatitis-related CLD, screening strategies for timely CLD diagnosis are warranted.
authors.affiliation: Department of Gastroenterology & Hepatology, Brighton & Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Kok Haw Jonathan
authors.initials: KH
authors.lastname: Lim
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Potts
authors.forename: John
authors.initials: J
authors.lastname: Chetwood
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goubet
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
mesh_terms: D000328:Adult; D000368:Aged; D001202:Ascitic Fluid / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008108:Liver Diseases, Alcoholic / Q000209:etiology / Q000401:mortality*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology / Q000401:mortality*; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: alcohol-related disorders; ascites; end stage liver disease; hepatorenal; liver transplantation; spontaneous bacterial peritonitis; syndrome