Spontaneous bacterial peritonitis risk factors: Difference between revisions
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* Severe [[liver]] disease ([[Cirrhosis]]) | * Severe [[liver]] disease ([[Cirrhosis]]) | ||
* Additional factors which can further increase susceptibility include: | * Additional factors which can further increase susceptibility include: | ||
* Low protein level in ascitic fluid <ref name="pmid20120777">{{cite journal |author=Mustafa MG, Al Mamun MA, Alam AK |title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis |journal=Bangladesh Med Res Counc Bull |volume=35 |issue=2 |pages= | * Low protein level in ascitic fluid <ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777 }} </ref> | ||
* Upper GI bleeding poses a risk of bacteremia and SBP in a cirrhotic patient with rates of infection ranging from 17 to 21% | * Upper GI bleeding poses a risk of bacteremia and SBP in a cirrhotic patient with rates of infection ranging from 17 to 21% | ||
* Ischemia- reperfusion of the gut during variceal hemorrhage has also been proposed to interfere with the normal function of the reticuloendothelial system and to increase permeability of the intestinal mucosa. | * Ischemia- reperfusion of the gut during variceal hemorrhage has also been proposed to interfere with the normal function of the reticuloendothelial system and to increase permeability of the intestinal mucosa. | ||
* Survivors of a prior episode of SBP are at an increased risk of recurrence with a one-year probability of almost 70%. | * Survivors of a prior episode of SBP are at an increased risk of recurrence with a one-year probability of almost 70%. | ||
* Minimally invasive procedures such as intravenous and urinary bladder catheterization likely predisposes to bacteremia and SBP in the cirrhotics. | * Minimally invasive procedures such as intravenous and urinary bladder catheterization likely predisposes to bacteremia and SBP in the cirrhotics. | ||
* Low complement concentration ([[C3 (complement)|complement 3]]) in ascitic fluid <ref name="pmid20120777">{{cite journal |author=Mustafa MG, Al Mamun MA, Alam AK |title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis |journal=Bangladesh Med Res Counc Bull |volume=35 |issue=2 |pages= | * Low complement concentration ([[C3 (complement)|complement 3]]) in ascitic fluid <ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777 }} </ref> | ||
* [[Renal failure]] | * [[Renal failure]] | ||
* [[Urinary tract infections]] | * [[Urinary tract infections]] | ||
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| valign = top | | | valign = top | | ||
''Well-established risk factors for developing an initial episode of SBP are'' : | ''Well-established risk factors for developing an initial episode of SBP are'' : | ||
* Low ascitic fluid protein level (<1 g/dL)<ref name="pmid20120777">{{cite journal |author=Mustafa MG, Al Mamun MA, Alam AK |title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis |journal=Bangladesh Med Res Counc Bull |volume=35 |issue=2 |pages= | * Low ascitic fluid protein level (<1 g/dL)<ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777 }} </ref> | ||
* Elevated serum bilirubin level (>4 mg/dL) | * Elevated serum bilirubin level (>4 mg/dL) | ||
* Advanced Cirrhosis | * Advanced Cirrhosis | ||
Revision as of 03:46, 17 January 2017
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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] Shivani Chaparala M.B.B.S [3]
Overview
Common risk factors in the development of spontaneous bacterial peritonitis include
- liver cirrhosis
- renal failure
- Low protein levels in the ascitic fluid
- Low complement concentration (complement 3) in ascitic fluid
- urinary tract infections, and
- Intestinal bacterial overgrowth.
Risk Factors
Risk factors include:[1]
- All cirrhotic patients with ascites
- Severe liver disease (Cirrhosis)
- Additional factors which can further increase susceptibility include:
- Low protein level in ascitic fluid [2]
- Upper GI bleeding poses a risk of bacteremia and SBP in a cirrhotic patient with rates of infection ranging from 17 to 21%
- Ischemia- reperfusion of the gut during variceal hemorrhage has also been proposed to interfere with the normal function of the reticuloendothelial system and to increase permeability of the intestinal mucosa.
- Survivors of a prior episode of SBP are at an increased risk of recurrence with a one-year probability of almost 70%.
- Minimally invasive procedures such as intravenous and urinary bladder catheterization likely predisposes to bacteremia and SBP in the cirrhotics.
- Low complement concentration (complement 3) in ascitic fluid [2]
- Renal failure
- Urinary tract infections
- Intestinal bacterial overgrowth [3]
| Risk Factors for SBP | |||
|---|---|---|---|
| Biochemical | Clinical | Genetic | Pharmacological |
|
Well-established risk factors for developing an initial episode of SBP are :
|
Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites. |
The Toll-like receptor 2 (TLR2) proteins variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP.[4] |
Proton pump inhibitors (PPI) has been associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
|
Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites.[5]
- Low serum sodium levels
- Child-Pugh stage C
- Elevated ascites PMN counts (≥100 cells/μl)
- MELD≥22
- Elevated CRP levels
References
- ↑ Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ 2.0 2.1 2.2 Mustafa MG, Al Mamun MA, Alam AK (2009). "Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis". Bangladesh Med Res Counc Bull. 35 (2): 41–3. PMID 20120777.
- ↑ van Erpecum KJ (2006). "Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis". Scand. J. Gastroenterol. Suppl. (243): 79–84. doi:10.1080/00365520600664342. PMID 16782626.
- ↑ Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F; et al. (2011). "Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis". J Hepatol. 55 (5): 1010–6. doi:10.1016/j.jhep.2011.02.022. PMID 21356257.
- ↑ Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A; et al. (2015). "Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites". Liver Int. 35 (9): 2121–8. doi:10.1111/liv.12795. PMID 25644943.