Mortality Related Factors in Patients with Spontaneous Bacterial Peritonitis

Year 2008, Volume: 35 Issue: 1, 10 - 15, 01.03.2008

Yekta Tüzün İlhan Kılınç Davut Akın Timuçin Çil Mansur Özcan

Abstract

Spontaneous Bacterial Peritonitis (SBP) is still an important complication of liver cirrhosis with ascites. Although new developments occurred it has a high mortality rate. In order to identify the related factors of mortality in cirrhotics with SBP, we studied 48 patients who fulfilled the accepted diagnostic criteria. All cases were treated with cefotaxime. The resolution rate was 87% in the study group. Eleven patients (22%) died in hospital. The major causes of death were hepatorenal syndrome (HRS) in 4 (36%) and variceal bleeding in 3 (27%). Fifty parameters were studied to find the correlation. Sixteen parameters (urea, bilirubin, MELD score, CTP score, prothrombin time, INR, AST, ALT, PMNL in ascites, systolic and diastolic arterial tension, sepsis, variceal bleeding, changes in mental status, HRS, culture positivity in ascites) were significantly correlated with mortality. Except for bilirubin, INR, AST and PMNL in ascites, the remaining parameters were also found to be predictive in logistic regression analysis. In multivariant analysis, we found that MELD score, INR, ALT, presence of mental change on admission and low mean arterial tension was significantly reduced the resolution of infection. We conclude that mortality in SBP patients mostly depends on the existence of recent variceal bleeding and the degree of liver and renal failure. Strict measures should be taken in cases with variceal bleeding and hepatorenal syndrome.

Keywords

Spontaneous Bacterial Peritonitis, Mortality

Spontan Bakteriyel Peritonit Hastalarında Mortalite İle İlişkili Faktörler

Abstract

Amaç: Bu retrospektif çalışma, 940 nanometre dalga boyu ile endovenöz lazer ablasyonun etkinlik ve kalıcılığını, Spontan Bakteriyel Peritonit (SBP) asitli sirotik hastalarda halen önemli bir komplikasyondur. Yeni gelişmelere rağmen yüksek mortalite oranlarına sahiptir. SBP\'li sirotik hastaların mortalitesiyle ilişkili faktörleri tanımlamak amacıyla tanı kriterlerini karşılayan 48 hasta çalışıldı. Tüm hastalar cefotaxime ile tedavi edildi. İyileşme oranı %87 idi. Hastane içi ölüm 11 (%22) kişide gerçekleşti. Major ölüm sebepleri 4 hastada (%36) hepatorenal sendrom ve 3 hastada (%27) varisiyel kanamaydı. İlişkinin araştırılması için 50 parametre çalışıldı. On altı parametre (üre, bilirubin, MELD skoru, CTP skoru, protrombin zamanı, INR, AST, ALT, asitte PMNL, sistolik ve diyastolik arteriyel tansiyon, sepsis, varisiyel kanama, mental durumda değişiklik, HRS, asitte kültür pozitifliği) mortalite ile istatistiksel anlamlı ilişki bulundu. Lojistik regresyon analizinde bilirubin, INR, AST ve asitte PMNL dışındaki parametrelerin mortalite için prediktif olduğu saptandı. Multivariant analizde MELD skoru, INR, ALT, başvuruda hastanın bilinç değişikliğinin olması ve ortalama arter basınçlarının düşük olmasının infeksiyon rezolüsyonunu anlamlı derecede azalttığı saptandı. Sonuç olarak SBP\'li hastalarda mortalite çoğunlukla yeni varisiyel kanama ve karaciğer ile böbrek yetersizliği derecesine bağlıdır. Varisiyel kanama ve hepatorenal sendromda sıkı önlemlerin alınması gerekmektedir.

Keywords

Spontan Bakteriyel Peritonit, Mortalite

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