Spontaneous bacterial peritonitis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Natural History , Complications and Prognosis

Spontaneous bacterial peritonitis (SBP) is a potentially fatal yet reversible cause of deterioration in patients with decompensated cirrhosis. SBP developing in the setting of ascites from causes other than cirrhosis is rare, but can occur in: Cardiac ascites, nephrogenic ascites, ascites associated with fulminant hepatic failure, malignant ascites, and alcoholic and viral hepatitis. Spontaneous bacterial peritonitis presents as a complication of ascites which can be due to cirrhosis , heart failure or renal failure. Untreated disease leads to complications and has a poor prognosis.

Natural History

• SBP has evolved from a universally fatal disease to a reversible and even preventable cause of deterioration or death in a patient with advanced cirrhosis.

Complications

• Sepsis
• Encephalopathy
• Liver failure
• Renal failure
• Tense ascites
• Coma
• Death

Prognosis

• The prognosis of SBP has improved dramatically since its first description.
• Inpatient mortality has declined from 100% in the 1960s to 60–70% in the 1970s and 1980s to 30% or less in studies performed in the past 10 years. This is likely due to earlier detection and effective, nontoxic therapy.
• Approximately half of all deaths in patients with SBP occur after resolution of the infection and are from gastrointestinal hemorrhage or liver or renal failure.
• One study showed an overall mortality of 37.8% in patients admitted with SBP, but only 2.2% were directly attributable to infection
• Patients surviving an episode of SBP should be considered for liver transplantation if acceptable.The use of selective intestinal decontamination (SID) with norfloxacin in patients admitted to the hospital with low-protein ascites has also shown a reduction in the incidence of SBP from 22.5 to 0%

Renal dysfunction is an important prognostic indicator followed by the Model for End-Stage Liver Disease (MELD) score. With an increase of MELD score prognosis becomes worse.