Hepatorenal syndrome, septic shock and renal failure as mortality predictors in patients with spontaneous bacterial peritonites

• Autor(a) principal: Rodrigues-Pinto,Eduardo
• Data de Publicação: 2012
• Outros Autores: Freitas-Silva,Margarida
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-81782012000600003
• topic: Peritonitis; Hepatorenal syndrome; Septic shock; Renal insufficiency

Background and aims: Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis. Identification of poor prognosis predictors is essential in disease approach. Methods: Medical records from patients admitted at our institution between January 2008 and December 2010 with spontaneous bacterial peritonitis were retrospectively reviewed. Criteria assessed were age, sex, presenting symptoms, risk factors, ascitic fluid characteristics, evolution during hospitalization, prophylaxis at discharge and re-admission. Results: 42 (34 male, 8 female) patients were included in the study. Mean age was 57.46± 13.4 years. Abdominal pain was the most common presenting symptom (59.5%); 69% of patients had Child-Pugh C. 7.1% have had previous episodes of spontaneous bacterial peritonitis, but only 2.4% were on antibiotic prophylaxis. 71.4% of first paracentesis were culture-negative. In the remaining, Escherichia coli (16.7%) was the agent most frequently isolated. 32.25% patients who started treatment with Ceftriaxone, were switched to another antibiotic. Average length of hospitalization was 16.10±12 days. Mortality rate was 28.6%. Of the variables analyzed with the methodology of Cox, hepatorenal syndrome (HR = 29.92, p < 0.001) and septic shock (HR = 9.5, p = 0.001) were significantly associated with higher mortality risk, with renal failure being suggestively associated (HR = 3.25, p = 0.063). Of the 71.4% patients discharged, 46.67% were on prophylaxis with 21.42% of them being re-admitted with the same diagnosis, while 31.25% discharged without prophylaxis were re-admitted (p = 0.36). Conclusion: The mortality is elevated, with hepatorenal syndrome and septic shock being potential predictors of mortality. Ceftriaxone fails in a high percentage of SBP episodes and may not be the most appropriate first-line treatment.