Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2020; 26(29): 4316-4326
Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4316
Multivariate predictive model for asymptomatic spontaneous bacterial peritonitis in patients with liver cirrhosis
Bo Tu, Yue-Ning Zhang, Jing-Feng Bi, Zhe Xu, Peng Zhao, Lei Shi, Xin Zhang, Guang Yang, En-Qiang Qin
Bo Tu, Zhe Xu, Peng Zhao, Lei Shi, Xin Zhang, Guang Yang, En-Qiang Qin, Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
Yue-Ning Zhang, Center of Hepatology and Gastroenterology, Beijing Capital Medical University You’an Hospital, Beijing 100039, China
Jing-Feng Bi, Department of Clinical and Translational Medicine, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
Author contributions: Tu B designed and performed the research and wrote the paper; Zhang YN designed the research and supervised the report, and contributed equally as the first author; Bi JF and Xu Z performed the research and contributed to the analysis; Zhao P, Shi L, Zhang X and Yang G performed the research and provided clinical advice; Qin EQ designed the research and supervised the report.
Supported by the Digestive Medical Coordinated Development Center of Beijing Municipal Administration, No. XXZ0403.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Chinese People's Liberation Army General Hospital.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: En-Qiang Qin, MD, Chief Physician, Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, 100 Western 4th Ring Middle Road, Beijing 100039, China.
Received: March 4, 2020
Peer-review started: March 4, 2020
First decision: April 12, 2020
Revised: June 2, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: August 7, 2020
Research background

Spontaneous bacterial peritonitis (SBP) is a detrimental infection of the ascitic fluid in liver cirrhosis patients, with high mortality and morbidity. Early diagnosis and timely antibiotic administration have successfully decreased the mortality rate to 20%-25%. Early diagnosis of asymptomatic SBP remains a great challenge in the clinic.

Research motivation

Currently, SBP cases are diagnosed based only on clinical symptoms, leading to possible antibiotic abuse. SBP is regulated by a variety of risk factors, including decreased activity of the reticuloendothelial system, advanced liver dysfunction, medications, and genetic factors. A multivariate predictive model may be effective for early screening of asymptomatic SBP.

Research objectives

The present retrospective cohort study aimed to establish an effective predictive model for early screening of asymptomatic SBP in liver cirrhosis patients with ascites. Early diagnosis of asymptomatic SBP will improve antibiotic management strategies and reduce SBP-associated mortality.

Research methods

Liver cirrhosis patients with ascites who had no typical SBP symptoms were included in the current study, and divided into the case (positive cultures) and control (negative cultures) groups according to microbiological results. The demographic features, clinical information, disease activity, hematological and ascites factors were compared between the case and control groups to identify potential indicators of asymptomatic SBP. The multiple linear stepwise regression method of the logistic regression model was adopted to construct the multivariate predictive model. The diagnostic performance of the model was estimated by the receiver operating characteristic curve.

Research results

Patients in the case group were more likely to have advanced disease stages, cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN (ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 × HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under curve value of the established model was 0.872, revealing its high diagnostic potential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7% (85/98), and the diagnostic efficacy was 80.1%.

Research conclusions

The multivariate predictive model based on model of end-stage liver disease, polymorphonuclear, blood neutrophil percentage, hepatocellular carcinoma, and renal dysfunction exerts high diagnostic efficacy which may improve the early diagnosis of asymptomatic SBP.