Spontaneous bacterial peritonitis risk factors
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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]
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[4] variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP. | * 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.
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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. Unknown parameter
|month=ignored (help) - ↑ 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.