Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2438
Peer-review started: May 14, 2019
First decision: June 9, 2019
Revised: July 12, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 6, 2019
Spontaneous peritonitis is one of the most common infectious complications in cirrhotic patients with ascites. However, spontaneous fungal peritonitis is a less recognized but devastating complication in end-stage cirrhosis.
To improve the survival rate, it is crucial to identify the risk factors for occurrence and mortality and to optimize stratification. Additionally, recognizing the clinical features is critical for the early diagnosis of spontaneous fungal peritonitis (SFP).
We aimed to illustrate the differences between SFP and spontaneous bacterial peritonitis (SBP) and discuss the risk factors for occurrence and short-term mortality of SFP.
In this case-control study, 138 cirrhotic patients with spontaneous peritonitis were recruited. Patients with SFP were included in a case group. Sex-, age-, and time-matched SBP patients were included in a control group. Furthermore, the control group was divided into control-1 group (positive bacterial culture) and control-2 group (negative bacterial culture), according to the bacterial culture result. Differences in the clinical features, laboratory examinations, severity models, and prognosis were compared between the case and control groups. The risk factors for the occurrence of SFP were identified by the logistic regression model. The short-term mortality of SFP was determined by the Cox regression model. Additionally, the predictive ability of different prognostic scoring systems was evaluated.
Patients with SFP had severe systemic inflammation, including higher white blood cell counts and C-reaction protein levels, and exhibited poor short-term mortality. However, no significant difference was found regarding the short-term mortality between patients with SFP and fungiascites. Long-term antibiotic administration dramatically increased the occurrence of SFP or fungiascites. The median length of antibiotic administration before the occurrence of SFP or fungiascites was 12 d in our study. Hepatorenal syndrome (HR = 5.328, 95%CI: 1.050-18.900) and total bilirubin (μmol/L, HR = 1.005, 95%CI: 1.002-1.008) represented independent predictors of SFP-related early mortality.
The present study found that long-term antibiotic administration increases the incidence of SFP and that hepatorenal syndrome and total bilirubin are closely related to short-term mortality.
Although a large sample size is required for further evaluation, our investigation provides a comprehensive study on characterizing the clinical features of SFP.