title: Predictive model of mortality in patients with spontaneous bacterial peritonitis.
abstract: Hospital mortality in patients with spontaneous bacterial peritonitis (SBP) is high despite albumin treatment, particularly in those with worse liver and/or renal function.
  
  
  
  To determine the independent predictive factors of in-hospital mortality and to create and validate a predictive model of mortality in patients with SBP.
  
  
  
  We analysed all cirrhotic patients with high-risk SBP (serum urea ≥11 mmol/L and/or serum bilirubin ≥68 μmol/L) between 2001 and 2011. We developed a predictive model of in-hospital mortality and validated this in a different cohort.
  
  
  
  We included 118 high-risk SBP episodes treated with antibiotics and albumin. In-hospital mortality was 33/118 (28%). The independent predictive factors of in-hospital mortality at SBP diagnosis were serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure. A predictive model including these four variables showed a discrimination accuracy (AUC) of 0.850, 95% CI 0.777-0.922. A cut-off point of 0.245 showed a sensitivity of 0.85 and specificity of 0.75. The in-hospital mortality was 28/49 (57.1%) in patients with a model value ≥0.245, and 5/69 (7.2%) in patients with a model value <0.245 (P < 0.001). The validation series included 161 patients with an in-hospital mortality of 40/161 (24.8%), 30/77 (39.0%) in patients with a model value ≥0.245, and 10/84 (11.9%) in those with a model value <0.245 (P < 0.001).
  
  
  
  We developed and validated a predictive model of mortality that includes serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure in high-risk patients with spontaneous bacterial peritonitis. These findings may help to identify patients who would benefit from additional therapeutic strategies.
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Poca
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Alvarado-Tapias
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Concepción
authors.affiliation: Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pérez-Cameo
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Cañete
authors.affiliation: Department of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.|CIBERsam, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Gich
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Romero
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Casas
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.|Escola Universitària d'Infermeria EUI-Sant Pau, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Román
authors.affiliation: Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Castells
authors.affiliation: Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Vargas
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Carrión
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Guarner
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.|CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000382:microbiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D000900:Anti-Bacterial Agents