title: Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites.
abstract: BACKGROUND
  Patients with ascites are at risk for developing spontaneous bacterial peritonitis (SBP) - a severe complication associated with high mortality. We aimed to identify risk factors for SBP development and mortality to optimize stratification for primary prophylaxis and therapeutic strategies to improve survival.
  
  
  METHODS
  575 patients with cirrhosis and ascites undergoing paracentesis at a tertiary care hospital were included in this retrospective cohort study. Demographical, clinical and laboratory parameters were recorded at first paracentesis and during follow-up. Multivariate logistic regression analysis was used to identify independent predictors of SBP development and mortality.
  
  
  RESULTS
  Child-Pugh stage C (OR: 3.323; P = 0.009), ascitic fluid polymorph-nuclear cell (PMN) count (OR: 1.544; P = 0.028) and low serum sodium (OR: 0.917; P = 0.029) emerged as independent risk factors for SBP development. SBP-naïve patients undergoing paracentesis and presenting with PMN-counts ≥100 cells/μl, or hyponatraemia <125 mM were at highest risk for developing SBP. Increases in MELD and CRP levels indicated SBP development, while no changes where observed in a matched control group with sterile ascites at multiple paracenteses. MELD score (OR: 1.565; P = 0.001) and CRP (OR: 1.067; P = 0.037) were identified as independent risk factors for 30-day mortality after SBP diagnosis. In particular SBP patients with MELD≥22, CRP ≥3.5 mg/dl and development of grade III/IV hepatic encephalopathy showed highest mortality.
  
  
  CONCLUSIONS
  Low serum sodium levels, Child-Pugh stage C and elevated ascites PMN counts (≥100 cells/μl) indicate a significant risk for SBP development. SBP-related mortality is highest in patients with MELD≥22 and elevated CRP levels.
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Philipp
authors: P
authors: Schwabl
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Theresa
authors: T
authors: Bucsics
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Kathrin
authors: K
authors: Soucek
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Mattias
authors: M
authors: Mandorfer
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Simona
authors: S
authors: Bota
authors: Division of Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors: Alexander
authors: A
authors: Blacky
authors: Division of Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors: Alexander M
authors: AM
authors: Hirschl
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Arnulf
authors: A
authors: Ferlitsch
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors: Michael
authors: M
authors: Trauner
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Markus
authors: M
authors: Peck-Radosavljevic
authors: Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.|Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria.
authors: Thomas
authors: T
authors: Reiberger
mesh_terms: D000368:Aged; D001201:Ascites / Q000150:complications / Q000209:etiology*; D001202:Ascitic Fluid / Q000382:microbiology; D001317:Austria; D001424:Bacterial Infections / Q000150:complications*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019152:Paracentesis; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D062606:Tertiary Care Centers
chemical_list: D012964:Sodium
keywords: ascites; cirrhosis; development; mortality; risk factors; spontaneous bacterial peritonitis