Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler

Öz

Giriş ve Amaç: Spontan bakteriyel peritonit, dekompanse karaciğer sirozunun sık görülen ve mortalitesi yüksek bir komplikasyonudur. Bu çalışmada spontan bakteriyel peritonitli sirotik hastalarda hastane içi mortaliteyi etkileyen faktörlerin saptanması amaçlandı. Gereç ve Yöntem: Hastanemiz Gastroenteroloji Kliniği’nde 5 yıllık periyot içinde hastanede yatan 129 sirotik hasta ve bu hastalarda gelişen 151 spontan bakteriyel peritonit epizodu retrospektif olarak değerlendirildi. Tüm hastaların demografik özellikleri, laboratuvar parametreleri, asit mayi tetkikleri, Child-Turcotte Pugh, son dönem karaciğer hastalığı modeli, sodyum-son dönem karaciğer hastalığı modeli skorları, siroz komplikasyonları incelendi ve sağ kalan grup ile exitus olan grup bu parametreler yönünden karşılaştırıldı. Bulgular: Hastaların %57.3’ü (n = 74) erkek ve %42.7’si (n = 55) kadındı, yaş ortalaması 60.4 ± 12.7 yıl (20 - 90) olarak bulundu. Hastalarda en sık siroz nedeni %32.6 oranı ile hepatit B virüsü idi. Hastaların %41.7’si Child-Turcotte Pugh-B ve %58.3’ü Child-Turcotte Pugh-C evresinde idi. Child-Turcotte Pugh-C evresinde hastane içi mortalite oranı Child-Turcotte Pugh-B evresinde göre anlamlı olarak yüksekti (p = 0.01). Exitus olan grupta lökosit ve nötrofil sayısı, kan üre nitrojeni, bilirübin, uluslararası normalleştirilmiş oran değeri ve asit mayi lökosit ve nötrofil sayısı sağ kalan gruba göre daha yüksek saptandı (p < 0.001). Child-Turcotte Pugh, son dönem karaciğer hastalığı modeli ve sodyum-son dönem karaciğer hastalığı modeli skorunun hastane içi mortalite ile ilişkili olduğu ve son dönem karaciğer hastalığı modeli skorunun hastane içi mortaliteyi öngörmede sodyum-son dönem karaciğer hastalığı modeli ve Child-Turcotte Pugh skorundan daha üstün olduğu bulundu (p < 0.001). Böbrek yetmezliği gelişen hastalarda hastane içi mortalite oranı daha yüksekti (%52.7’ye karşı %12.5; p < 0.001). Hepatik ensefalopati (%48.9’a karşı %17.3; p < 0.001), hepatorenal sendrom (%85.7’ye karşı %13.8; p < 0.001) ve diğer enfeksiyonların gelişimi (%48.5’e karşı %21.2; p = 0.003) ile hastane içi mortalite arasında anlamlı ilişki saptandı. Sonuç: Spontan bakteriyel peritonitli hastalarda lökosit ve nötrofıl yüksekliği, kan üre nitrojeni, bilirübin, uluslararası normalleştirilmiş oran, asit mayi lökosit ve asit mayi nötrofil sayısı yüksekliği hastane içi mortaliteyi olumsuz yönde etkilemektedir. Hastalarda böbrek yetmezliği gelişimi, asit mayi kültür pozitifliği, hepatik ensefalopati, hepatorenal sendrom ve enfeksiyon gelişimi hastane içi mortaliteyi arttırmaktadır. Skorlama sistemlerinden son dönem karaciğer hastalığı modeli skoru, hastane içi mortaliteyi öngörmede sodyum-son dönem karaciğer hastalığı modeli ve Child-Turcotte Pugh skorundan daha üstündür.

Anahtar Kelimeler

• Siroz
• hastane içi mortalite
• spontan bakteriyel peritonit

Factors affecting in-hospital mortality in patients with spontaneous bacterial peritonitis

Öz

Background and Aims: Spontaneous bacterial peritonitis is a common complication of decompensated liver cirrhosis with a high mortality rate. The aim of this study was to determine the factors affecting in-hospital mortality in cirrhotic patients with spontaneous bacterial peritonitis. Materilas and Method: 129 patients with cirrhosis who were hospitalized in the Gastroenterology Clinic of our Hospital within a 5-year period and 151 episodes of spontaneous bacterial peritonitis developed in these patients were evaluated retrospectively. Demographic characteristics, laboratory parameters, ascitic fluid tests, Child-Turcotte Pugh, Model for End-stage Liver Disease, sodium-Model for End-stage Liver Disease scores, complications of cirrhosis were examined in all patients, and the surviving group and the exitus group were compared in terms of these parameters. Results: Of the patients, 57.3% (n = 74) were male and 42.7% (n = 55) were female. The mean age of the patients was 60.4 ± 12.7 (20-90). Hepatitis B virus was the most common cause of cirrhosis with a rate of 32.6%. Cirrhosis stage was Child C and Child B in 58.3% and in 41.7% of the patients respectively. In-hospital mortality rate was significantly higher in patients with Child B cirrhosis stage than those with Child C (p = 0.01). The leukocyte and neutrophil counts, blood urea nitrogen, bilirubin, international normalised ratio values and ascites leukocyte and neutrophil counts were found to be higher in the exitus group than the surviving group (p < 0.001). It was found that Child-Turcotte Pugh, Model for End-stage Liver Disease and sodium-Model for End-stage Liver Disease scores were associated with in-hospital mortality, and Model for End-stage Liver Disease score was superior to sodium-Model for End-stage Liver Disease and Child-Turcotte Pugh scores in predicting in-hospital mortality (p < 0.001). In-hospital mortality rate was higher in patients who developed renal failure (12.5% versus 52.7%; p < 0.001). There was a significant relationship between in-hospital mortality and hepatic encephalopathy (48.9% vs. 17.3%; p < 0.001), hepatorenal syndrome (85.7% vs. 13.8%; p < 0.001), and the development of infections other than spontaneous bacterial peritonitis (48% vs. %21,2; p = 0.003). Conclusion: In patients with spontaneous bacterial peritonitis, elevated leukocytes and neutrophils, high blood urea nitrogen, bilirubin, international normalised ratio values, and high ascitic leukocytes and ascitic fluid neutrophil counts affect in-hospital mortality negatively. Development of renal failure, positive culture of ascitic fluid, hepatic encephalopathy, hepatorenal syndrome and infection other than spontaneous bacterial peritonitis increase in-hospital mortality. Of the scoring systems, the Model for End-stage Liver Disease score is superior to the sodium-Model for End-stage Liver Disease and Child-Turcotte Pugh score in predicting in-hospital mortality.

Anahtar Kelimeler

• Cirrhosis
• in-hospital mortality
• spontaneous bacterial peritonitis

Kaynakça

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