DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172096

Study of etiology, clinical profile and predictive factors of spontaneous bacterial peritonitis in cirrhosis of liver

Juhi B. Kawale, Kavita J. Rawat

Abstract


Background: Spontaneous bacterial peritonitis (SBP) is one of the potentially lethal complication of liver cirrhosis and is defined as infected ascites in the absence of any recognizable secondary cause of infection. Majority of the SBP cases are caused by organism from the gastrointestinal tract mainly aerobic gram-negative organisms- Escherichia coli being the most common etiological agent.

Methods: It was a prospective observational study done over a period of 1 year in a tertiary care hospital. 50 patients from medical and gastroenterology wards were included in the study. Patients above 12 year of age with diagnosed cirrhosis of liver and documented evidence of SBP were included. Pregnant females, patients who refused to give consent, patients with a documented evidence of intra-abdominal source of infection or patients with ascitis due to non-hepatic causes were excluded.

Results: The high serum bilirubin and creatinine levels were associated with higher mortality rate. Hepatic encephalopathy is associated with worse outcome. The outcome of the patient in relation to the grades of ascitis, liver enzymes, prothrombin time, international normalised ratio (INR), Child pugh grades, ascitic fluid polymorphonuclear leucocyte count, ascitic fluid culture and blood culture were not statistically significant.

Conclusions: A high index of suspicion should exist for SBP in patients with cirrhosis and ascitis. Serum creatinine and bilirubin levels are strong predictors of mortality. Hepatic encephalopathy has a strong association with mortality in patients with spontaneous bacterial peritonitis.


Keywords


Liver cirrhosis, SBP

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References


Schiff L, Eugene R, Schiff M. Cirrhosis. In Raven, Editor. Disease of the Liver. (8th ed.). Philadelphia: Lippincott; 1999:20-725.

Conn HO, Fessel JM. Spontaneous bacterial peritonitis in cirrhosis: variations on a theme. Medicine. 1971;50(3):161-97.

Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterol. 2001;120(3):726-48.

Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28(1):26-42.

Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatol. 1984;4(1):53-8.

Fernandez J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatol. 2000;35(1):140-8.

Nobre SR, Cabral JE, Gomes JJ, Leitão MC. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model. Eur J Gastroenterol Hepatol. 2008;20(12):1176-81.

Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis - in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 2001;96(4):1232-6.

Navasa M, Rimola A, Rodés J. Bacterial infections in liver disease. Semin Liver Dis. 19978;17:323-33.

Johnson DH, Cunha BA. Infections in cirrhosis. Infect Dis Clin North Am. 2001;15:363-71.

Navasa M, Rodés J. Bacterial infections in cirrhosis. Liver Int. 2004;24:277-80.

Garcia-Tsao G. Bacterial infections in cirrhosis. Can J Gastroenterol. 2004;18:405-6.

Bunchorntavakul C, Chavalitdhamrong D. Bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. World J Hepatol. 2012;4:158-68.

Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008;28:26-42.

Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut. 2012;61:297-310.

Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol. 2014;60:1310-24.

Mane M, Mane P, Prajapati P, Afzalpurkar S, Aundhkar A, John D. Study of frequency of spontaneous bacterial peritonitis in patients with alcoholic liver cirrhosis with ascitis. Int J Contemporary Med Res. 2016;3(7):2057-9.

Nadagouda SB, Mahesh CB, Kashinakunti SV, Birader MS. Spontaneous bacterial peritonitis in cirrhosis of liver with ascites-a cross sectional study. Int J Biol Med Res. 2013;4(2):3143-7.

Purohit PH, Malek SS, Desai KJ, Sadadia M. A study of bacteriological profile of ascitic fluid in suspected clinical cases of spontaneous bacterial peritonitis at a tertiary care hospital in India. Inter J Med Sci Public Health. 2015;4:4.

Oladmeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunler DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascitis. Pan Afr Med J. 2013;15:128.

Baheti R. Seroprevalence of HCV antibodies in patients with liver disorders. JAPI. 2000;48(1):26.

Andreu M, Sola R, Sitges-Serra A. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Gastroenterol. 1993;104:1133-8.

Runyon BA. Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterol. 1986;91:1343-6.

Runyon BA, Morrisey R, Hoefs JC. Opsonic activity of human ascitic fluid: A potentially important protective mechanism against spontaneous bacterial peritonitis. Hepatol. 1985;5:634-7.

Kurtz RC, Bronzo RL. Does spontaneous bacterial peritonitis occur in malignant ascites? Am J Gastroenterol. 1982;77:146-8.

Runyon BA. Spontaneous bacterial peritonitis associated with cardiac ascites. Am J Gastroenterol. 1984;79:796.

Musskopf MI, Fonseca FP, Gass J, de Mattos AZ, John JA, de Mello Brandão AB. Prognostic factors associated with in hospital mortality in patients with spontaneous bacterial peritonitis. Ann Hepatol. 2012;11(6):915-20.

Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2011;9:260-5.

Pugh RN, Murray-Lyon IM, Dawson JL. Transection of the esophagus for bleeding esophageal varices. Br J Surgery. 1973;60:646-9.

Bandy SM, Tuttle A. Spontaneous bacterial peritonitis. E-medicine from WebMD. Updated. 2008;16.

Llach J, Rimola A, Navasa M, Ginès P, Salmerón JM, Ginès A, et al. Incidence and predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with ascites: Relevance of ascitic fluid protein concentration. Hepatol. 1992;16:724-7.

Mohammad T, Ali A, Noor-ul-iman. Yield of ascitic fluid culture in SBP in Cirrhosis. J Med Sci. 2010;18(1):59-62.

Haider I, Ahmad I, Bashir H Causative organisms and their drug sensitivity pattern in ascitic fluid of cirrhotic patients with SBP. J Postgrad Med Inst. 2008;22:333-9.

Tsung PC, Ryu SH, Cha IH, Cho HW, Kim JN, Kim YS, Moon JS. Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. Clin Mol Hepatol. 2013;19(2):131-9.