Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 28, 2016; 8(12): 566-572
Published online Apr 28, 2016. doi: 10.4254/wjh.v8.i12.566
Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis
Chinmaya Kumar Bal, Ripu Daman, Vikram Bhatia
Chinmaya Kumar Bal, Ripu Daman, Vikram Bhatia, Department of Hepatology, Institute of Liver and Biliary Science, New Delhi 110070, India
Author contributions: Bal CK contributed to conception and study design, acquisition of data, statistical analysis and interpretation of data, preparation of graphs and final approval of article; Daman R contributed to data collection, drafting and final approval of manuscript; Bhatia V contributed to conception and study design, drafting and the final approval of manuscript.
Institutional review board statement: This study was reviewed and approved by the Institutional Ethics Committee of Institute of Liver and Biliary Sciences, dated June 5th 2013.
Informed consent statement: The entire study participants, or their legal guardians, have provided written informed consent prior to study enrolment.
Conflict-of-interest statement: There is no conflict of interest in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chinmaya Kumar Bal, MBBS, Department of Hepatology, Institute of Liver and Biliary Science, Sector D1, Vasant Kunj, New Delhi 110070, India. chinmaya.bal@gmail.com
Telephone: +91-11-46300000 Fax: +91-11-4630001
Received: January 12, 2016
Peer-review started: January 14, 2016
First decision: February 2, 2016
Revised: February 28, 2016
Accepted: April 7, 2016
Article in press: April 11, 2016
Published online: April 28, 2016
Abstract

AIM: To determine the predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis (SBP).

METHODS: Two hundred and eighteen patients admitted to an intensive care unit in a tertiary care hospital between June 2013 and June 2014 with the diagnosis of SBP (during hospitalization) and cirrhosis were retrospectively analysed. SBP was diagnosed by abdominal paracentesis in the presence of polymorphonuclear cell count ≥ 250 cells/mm3 in the peritoneal fluid. Student’s t test, multivariate logistic regression, cox proportional hazard ratio (HR), receiver operating characteristics (ROC) curves and Kaplan-Meier survival analysis were utilized for statistical analysis. Predictive abilities of several variables identified by multivariate analysis were compared using the area under ROC curve. P < 0.05 were considered statistical significant.

RESULTS: The 50 d in-hospital mortality rate attributable to SBP is 43.11% (n = 94). Median survival duration for those who died was 9 d. In univariate analysis acute kidney injury (AKI), hepatic encephalopathy, septic shock, serum bilirubin, international normalized ratio, aspartate transaminase, and model for end-stage liver disease - sodium (MELD-Na) were significantly associated with in - hospital mortality in patients with SBP (P≤ 0.001). Multivariate cox proportional regression analysis showed AKI (HR = 2.16, 95%CI: 1.36-3.42, P = 0.001) septic shock (HR = 1.73, 95%CI: 1.05-2.83, P = 0.029) MELD-Na (HR = 1.06, 95%CI: 1.02-1.09, P≤ 0.001) was significantly associated with 50 d in-hospital mortality. The prognostic accuracy for AKI, MELD-Na and septic shock was 77%, 74% and 71% respectively associated with 50 d in-hospital mortality in SBP patients.

CONCLUSION: AKI, MELD-Na and septic shock were predictors of 50 d in-hospital mortality in decompensated cirrhosis patients with SBP.

Keywords: Decompensated cirrhosis, Acute kidney injury, Model for end-stage liver disease sodium, Septic shock, Spontaneous bacterial peritonitis

Core tip: Spontaneous bacterial peritonitis (SBP) is associated with poor prognosis especially with in-hospital patients. The mortality rate ranges from 20%-40%. The model for end-stage liver disease (MELD) has been suggested as a predictor of the in-hospital mortality in patients with SBP. However, the role of other predictors has not been established. The goal of this study is to identify other prognostic factors for mortality in decompensated cirrhotic patients with SBP and to evaluate the predictive power of acute kidney injury, MELD-sodium and septic shock.