Spontaneous bacterial peritonitis: a prospective Greek multicenter study of its epidemiology, microbiology, and outcomes

Dimitrios N. Samonakis; Nikolaos Gatselis; Aristea Bellou; Dimitra Sifaki-Pistolla; Maria Mela; George Demetriou; Evangelos Thalassinos; Eirini I. Rigopoulou; Polyxeni Kevrekidou; Ioannis Tziortziotis; Kalliopi Azariadi; Melina Kavousanaki; Emmanuel Digenakis; Themistoklis Vassiliadis; Elias A. Kouroumalis; George N. Dalekos

Authors Dimitrios N. Samonakis, Nikolaos Gatselis, Aristea Bellou, Dimitra Sifaki-Pistolla, Maria Mela, George Demetriou, Evangelos Thalassinos, Eirini I. Rigopoulou, Polyxeni Kevrekidou, Ioannis Tziortziotis, Kalliopi Azariadi, Melina Kavousanaki, Emmanuel Digenakis, Themistoklis Vassiliadis, Elias A. Kouroumalis, George N. Dalekos.

Abstract

Background Spontaneous bacterial peritonitis (SBP) is an ominous complication of decompensated cirrhosis. This study aimed to assess several epidemiological, clinical, microbiological and outcome characteristics in Greek patients with SBP, as no solid representative nationwide data of this type was available.

Methods During a 3-year period, 77 consecutive patients with SBP (61 male; median age: 67 years; model for end-stage liver disease [MELD] score: 20), diagnosed and followed in 5 tertiary liver units, were prospectively recruited and studied. Various prognostic factors for disease outcome were studied.

Results Thirty-eight patients had alcohol-related cirrhosis, 17 viral hepatitis, 6 non-alcoholic steatohepatitis, 6 autoimmune liver diseases, and 10 cryptogenic cirrhosis. Hepatocellular carcinoma (HCC) was present in 23 (29.9%), whereas 10 (13%) had portal vein thrombosis. The first SBP episode at baseline was community-acquired in 53 (68.8%), while in 24 (31.1%) was hospital-acquired, with predominant symptoms abdominal pain and encephalopathy. A positive ascitic culture was documented in 36% of patients in the initial episode, with almost equal gram (+) and gram (–) pathogens, including 3 multidrug-resistant pathogens. Significant factors for 6-month survival were: higher MELD score, previous β-blocker use, lower serum albumin, higher lactate on admission and need for vasopressors, while factors for 12-month survival were MELD score and lactate. For overall survival, higher MELD score and lactate along with HCC presence were negative predictive factors.

Conclusions MELD score, lactate, albumin, HCC and treatment with vasopressors were predictive of survival in SBP patients. In hospital-acquired SBP the prevalence of difficult-to-treat pathogens was higher.

Keywords Cirrhosis, spontaneous bacterial peritonitis, mortality, lactate, MELD score

Ann Gastroenterol 2022; 35 (1): 80-87