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] Shivani Chaparala M.B.B.S [3]
Overview
SBP is common and indicates a poor prognosis.
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. Uncomplicated SBP is defined as spontaneous bacterial peritonitis in the absence of shock, hemorrhage, ileus, severe renal failure and severe encephalopathy.
Natural History
- Spontaneous bacterial peritonitis is a well-known complication of Cirrhotic ascites.
- A longitudinal study conducted in 263 cirrhotic patients (HCV related in 127 cases and alcoholic in 136 cases) with a mean age of 6 I .2+/- I I .4 years), after the first ascites decompensation to evaluate the probability of SBP development, which describes the natural history of SBP and the results include the following:[1]
- Approximately 25% of cirrhotic patients developed SBP within the first 3 years after the first ascites decompensation, mainly if they have an ascitic fluid protein concentration below 10g/L. Although the SBP resolution was achieved in almost 90% ofcases, SBP-induced renal failure appeared in a third of the patients and it was associated with a short survival-rate.
- 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.[2]
Complications
Prognosis
- The prognosis of SBP has improved dramatically since its first description. [2]
- 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
- The presence of renal insufficiency is the strongest independent prognostic indicator, but the presence of peripheral leukocytosis, older age, higher Child-Pugh score, and the presence of an ileus have also been shown to predict inpatient mortality. Patients with hospital versus community-acquired SBP also appear to have a higher mortality.
- 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. [3]
- The grave prognosis associated with a diagnosis of SBP in in-patients may not be applicable to outpatients with neutrocytic ascites.[4]
References
- ↑ Canete, N.; Erice, E.; Bargallo, A.; Cirera, I.; Masnou, H.; Miquel, M.; Coll, S.; Gimenez, M.D.; Galeras, J.A.; Morillas, R.M.; Planas, R.; Sola, R. (2007). "[219] NATURAL HISTORY OF SPONTANEOUS BACTERIAL PERITONITIS: A LONGITUDINAL STUDY IN 263 CIRRHOTIC PATIENTS AFTER THE FIRST ASCITES DECOMPENSATION". Journal of Hepatology. 46: S90–S91. doi:10.1016/S0168-8278(07)61817-0. ISSN 0168-8278.
- ↑ 2.0 2.1 Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ Tandon P, Garcia-Tsao G (2011). "Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis". Clin. Gastroenterol. Hepatol. 9 (3): 260–5. doi:10.1016/j.cgh.2010.11.038. PMID 21145427. Unknown parameter
|month=ignored (help) - ↑ Evans LT, Kim WR, Poterucha JJ, Kamath PS (2003). "Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites". Hepatology. 37 (4): 897–901. doi:10.1053/jhep.2003.50119. PMID 12668984.