Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica / Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice

ABSTRACT

OBJECTIVES: To assess survival and predictive factors ofmortality after an episode of spontaneous bacterial peritonitis(SBP) in cirrhotic patients and to analyze the diagnosticand therapeutic measures used.METHODS: We retrospectively reviewed the medical recordsof 158 consecutive episodes of SBP treated between January2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independentpredictive factors of mortality were obtained by a Cox regressionmodel, while independent predictive factors of inhospitalmortality were obtained by logistic regressionanalysis.RESULTS: A total of 80.4% of the SBP episodes occurred inmen and the mean age was 61.23 ± 12.49 years. The mostfrequent etiology of cirrhosis was viral (51.3%), followed byalcoholic (39.9%). The distribution of Child-Pugh classificationwas 5.7% (A), 63.3% (B) and 31% (C). Overall 3-yearsurvival in the sample was 43.3%. Four variables were identifiedas independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy,diagnosis of hepatocellular carcinoma (HCC) andmean arterial pressure (MAP) < 75 mmHg. At the end of themonitoring period, the results of the analysis were as follows:diagnosis of HCC, MAP < 75 mmHg, and age > 65 years.Microbiological detection was achieved in 21% of theepisodes. The most frequent microorganisms detected wereEscherichia coli in ascitic fluid and Staphylococcus aureus inblood cultures.CONCLUSIONS: SBP has a poor short- and long-term prognosisin cirrhotic patients. Independent predictive factors ofshort-term survival are renal impairment, hepatic encephalopathy,MAP < 75 mmHg, and the presence of HCC (AU)