Trad D*, Sabbah M, Jlassi H, Ouakaa A, Bibani N, Elloumi H and Gargouri D
Department of Gastroenterology, Habib Thameur Hospital, TunisiaFulltext PDF
Introduction: Spontaneous Bacterial Peritonitis (SBP) is a diagnostic and therapeutic emergency, which is a turning point in the natural history of the cirrhosis. Predictive factors of recurrence and survival after first episode of SBP in cirrhotic patients remain until now little known. Identifying these factors could improve the management of these patients. The aims of this study were to assess the prevalence and the risk factors for recurrence after a first episode of SBP in cirrhotic patients and to evaluate its impact on the prognosis. Methods: We conducted a retrospective study including consecutive cirrhotic patients admitted in the Gastroenterology Department of Habib Thameur Hospital for the management of a first episode of SBP between January 2003 and December 2017. Patients, cirrhosis and first episode of SBP characteristics were studied. The occurrence of a recurrence during follow-up was investigated. Predictive factors for SBP recurrence and its impact on the survival were evaluated in patients who were on secondary prophylaxis. Results: Eight hundred and twelve cirrhotic patients were collected. Our study focused on 90 patients who developed a first episode of SBP, meaning a prevalence of 11%. The mean age at diagnosis was 63 years. The sex ratio (M/F) was 0.66. Most of cirrhosis was due to viral hepatitis (54%). Child Pugh score was B in 51% of cases and C in 49% of cases. The average MELD score was 21 [range 9 to 41]. The infection was nosocomial in 18% of cases. The average protein concentration in ascitic fluid was 14.86 g/l. Antibiotic therapy was mainly based on third-generation cephalosporins (94%). Eighteen percent of patients required escalation of antimicrobial treatment. Hospital mortality following the first episode of SBP was 10%. The SBP recurrence rate was 26% among patients who survived their first infectious episode. The average time to the occurrence of the first SBP recurrence compared to the first episode was 162 days. Predictive factors of SBP recurrence in univariate analysis were beta blocker use, refractory ascites, portal hypertensive gastropathy, the presence of hepatic encephalopathy at admission, high CRP level at admission with a cut off 30 mg/l and high MELD score with a cut off 17. In multivariate analysis, only portal hypertensive gastropathy was an independent factor of SBP recurrence (p=0.04). In terms of prognostic impact, SBP recurrence was associated with a decrease in survival, from 12.2 months in the absence of recurrence to 7.2 months in case of recurrence (p=0.6). Conclusion: In these present study, prevalence of SBP recurrence was 2.58%. It was often early and greatly reduced survival. The presence of portal hypertensive gastropathy may be useful in predicting recurrence of SBP.
Spontaneous bacterial peritonitis; Cirrhotic patients; Hepatitis
Trad D, Sabbah M, Jlassi H, Ouakaa A, Bibani N, Elloumi H, Gargouri D. Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Predictive Factors of Recurrence and Survival. Ann Clin Hepatol. 2019; 3(2): 1013..