Factores pronósticos de mortalidad en la cirrosis hepática tras un primer episodio de peritonitis bacteriana espontánea. Estudio multicéntrico / Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study

Introducción: la peritonitis bacteriana espontánea es una complicación infecciosa con impacto negativo sobre la supervivencia de los pacientes con cirrosis. Objetivo: analizar la supervivencia a corto y largo plazo después de un primer episodio de peritonitis bacteriana espontánea y los factores pronósticos asociados. Material y métodos: estudio multicéntrico retrospectivo que incluyó a los pacientes ingresados por peritonitis bacteriana espontánea entre 2008 y 2013. Las variables independientes relacionadas con la mortalidad se analizaron mediante regresión logística. Se analizó el poder pronóstico de los índices Child Pugh, MELD y Charlson mediante curva de ROC. Resultados: fueron incluidos 159 pacientes. El 72% fueron hombres con una edad media de 63,5 años y con una puntuación MELD de 19 (DE ± 9,5). La mortalidad a los 30 días, 90 días, al año y a los dos años fue del 21%, 31%, 55% y 69%, respectivamente. La encefalopatía hepática (p = 0,008; OR 3,5; IC 95% 1,4-8,8) y la función renal (p = 0,026; OR 2,7; IC 95% 1,13-16,7) fueron factores independientes de mortalidad a corto y largo plazo. El MELD fue un buen indicador de supervivencia a corto y largo plazo (área bajo la curva [AUC] 0,7: IC 95% 1,02-1,4). El índice de Charlson se relacionó con la mortalidad a largo plazo (AUC 0,68: IC 95% 0,6-0,77). Conclusiones: en la peritonitis bacteriana espontánea la mortalidad a corto y largo plazo sigue siendo elevada. Los principales factores pronósticos de mortalidad son el deterioro de la función hepática y renal. El MELD y el índice de Charlson son unos buenos indicadores de supervivencia (AU)

Introduction: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. Objective: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. Patients and methods: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. Results: A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). Conclusions: Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival (AU)

Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study.

INTRODUCTION: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis. OBJECTIVE: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors. PATIENTS AND METHODS: This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve. RESULTS: A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77). CONCLUSIONS: Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival.