Spontaneous bacterial peritonitis risk factors: Difference between revisions

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__NOTOC__
__NOTOC__
{{Spontaneous bacterial peritonitis}}
{{Spontaneous bacterial peritonitis}}
{{CMG}} ; {{AE}} {{ADI}}
{{CMG}} ; {{AE}} {{SCh}} {{AY}}


==Overview==
==Overview==
Common risk factors in the development of spontaneous bacterial peritonitis include
Common risk factors in cirrhotic patients with [[ascites]] include: low [[protein]] level in ascitic fluid (<1 g/dL), upper [[GI bleeding]], low [[complement]] concentration ([[C3 (complement)|complement 3]]) in ascitic fluid, [[renal failure]], elevated serum [[bilirubin]] level (>4 mg/dL), use of [[proton pump inhibitors]] ([[PPI]]) in cirrhotic patients have an increased risk, [[Child-Pugh score|Child-Pugh]] stage C, [[MELD score|Model For End-Stage Liver Disease (MELD)]] ≥ 22.
*[[liver cirrhosis]]
* [[renal failure]]
* Low protein levels in the ascitic fluid
* Low complement concentration ([[C3 (complement)|complement 3]]) in ascitic fluid
* [[urinary tract infection]]s, and
* Intestinal [[bacterial overgrowth]].


==Risk Factors==
==Risk Factors==
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Risk factors include:<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref>
Risk factors include:<ref name="pmid15920324">{{cite journal| author=Sheer TA, Runyon BA| title=Spontaneous bacterial peritonitis. | journal=Dig Dis | year= 2005 | volume= 23 | issue= 1 | pages= 39-46 | pmid=15920324 | doi=10.1159/000084724 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15920324  }} </ref>
* All cirrhotic patients with ascites  
* All cirrhotic patients with ascites  
* Severe [[liver]] disease ([[Cirrhosis]])
* Severe [[liver disease]] ([[Cirrhosis]])<ref name="pmid8462803">{{cite journal| author=Andreu M, Sola R, Sitges-Serra A, Alia C, Gallen M, Vila MC et al.| title=Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. | journal=Gastroenterology | year= 1993 | volume= 104 | issue= 4 | pages= 1133-8 | pmid=8462803 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8462803  }} </ref>
* Additional factors which can further increase susceptibility include:
* Low [[protein]] level in ascitic fluid <ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777  }} </ref>
* Low protein level in ascitic fluid <ref name="pmid20120777">{{cite journal |author=Mustafa MG, Al Mamun MA, Alam AK |title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis |journal=Bangladesh Med Res Counc Bull |volume=35 |issue=2 |pages=41–3 |year=2009 |month=August |pmid=20120777 |doi= |url=}}</ref>
* Upper [[GI bleeding]] poses a risk of [[bacteremia]] and SBP in a cirrhotic patient with rates of infection ranging from 17 to 21%
* Upper GI bleeding poses a risk of bacteremia and SBP in a cirrhotic patient with rates of infection ranging from 17 to 21%
* Ischemia- reperfusion of the gut during variceal hemorrhage has also been proposed to interfere with the normal function of the [[reticuloendothelial system]] and to increase permeability of the [[intestinal mucosa]]
* Ischemia- reperfusion of the gut during variceal hemorrhage has also been proposed to interfere with the normal function of the reticuloendothelial system and to increase permeability of the intestinal mucosa.
* Survivors of a prior episode of SBP are at an increased risk of recurrence with a one-year probability of almost 70%
* Survivors of a prior episode of SBP are at an increased risk of recurrence with a one-year probability of almost 70%.
* Minimally invasive procedures such as intravenous and urinary bladder [[catheterization]] likely predisposes to bacteremia and SBP in the cirrhotics
* Minimally invasive procedures such as intravenous and urinary bladder catheterization likely predisposes to bacteremia and SBP in the cirrhotics.
* Low [[complement]] concentration ([[C3 (complement)|complement 3]]) in ascitic fluid <ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777  }} </ref><ref name="pmid8462803">{{cite journal| author=Andreu M, Sola R, Sitges-Serra A, Alia C, Gallen M, Vila MC et al.| title=Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites. | journal=Gastroenterology | year= 1993 | volume= 104 | issue= 4 | pages= 1133-8 | pmid=8462803 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8462803  }} </ref>
* Low complement concentration ([[C3 (complement)|complement 3]]) in ascitic fluid <ref name="pmid20120777">{{cite journal |author=Mustafa MG, Al Mamun MA, Alam AK |title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis |journal=Bangladesh Med Res Counc Bull |volume=35 |issue=2 |pages=41–3 |year=2009 |month=August |pmid=20120777 |doi= |url=}}</ref>
* [[Renal failure]]
* [[Renal failure]]
* [[Urinary tract infections]]
* [[Urinary tract infections]]
* Intestinal [[bacterial overgrowth]] <ref name="pmid16782626">{{cite journal |author=van Erpecum KJ |title=Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis |journal=Scand. J. Gastroenterol. Suppl. |volume= |issue=243 |pages=79–84 |year=2006 |pmid=16782626 |doi=10.1080/00365520600664342 |url=}}</ref>
* Intestinal [[bacterial overgrowth]] <ref name="pmid16782626">{{cite journal |author=van Erpecum KJ |title=Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis |journal=Scand. J. Gastroenterol. Suppl. |volume= |issue=243 |pages=79–84 |year=2006 |pmid=16782626 |doi=10.1080/00365520600664342 |url=}}</ref>
* The use of non-selective [[beta blockers]] in [[cirrhosis|cirrhotic]] patients with SBP should be discouraged since it is associated with an increased risk for [[hemodynamic compromise]], prolonged [[hospitalization]], [[hepatorenal syndrome]], and [[acute kidney injury]]<ref name="pmid24631577">{{cite journal| author=Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M et al.| title=Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. | journal=Gastroenterology | year= 2014 | volume= 146 | issue= 7 | pages= 1680-90.e1 | pmid=24631577 | doi=10.1053/j.gastro.2014.03.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24631577  }} </ref>
Factors contributing to the infection include:
* [[GI bleeding]]
*Increased colonization of the small bowel with prominent bacterial translocation
*Decreased [[Opsonin|opsonic activity]] in blood and ascitic fluid
* Impaired [[complement]]
* [[Leukocyte]] dysfunction
*Reduced [[antibodies]]
*Increased [[immunosuppressive]] [[cytokines]], endotoxin, [[TNF]]
{| class="wikitable"
! colspan="4" |Risk Factors for SBP
|-
! style="width: 25%;" |Biochemical
! style="width: 25%;" |Clinical
! style="width: 25%;" |Genetic
! style="width: 25%;" |Pharmacological
|-
| valign="top" |
''Well-established risk factors for developing an initial episode of SBP are'' :
* Low ascitic fluid [[protein]] level (<1 g/dL)<ref name="pmid20120777">{{cite journal| author=Mustafa MG, Al Mamun MA, Alam AK| title=Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis. | journal=Bangladesh Med Res Counc Bull | year= 2009 | volume= 35 | issue= 2 | pages= 41-3 | pmid=20120777 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20120777  }} </ref>
* Elevated serum [[bilirubin]] level (>4 mg/dL)
* Advanced [[Cirrhosis]]
* Low levels of [[25-hydroxy vitamin D]]
* Serum [[Serum albumin|albumin]] level <2.85 g/dL
| valign="top" |
* Patients with [[Variceal bleed|variceal hemorrhage]] and [[Gastrointestinal bleeding|GI bleeding]] associated with [[cirrhosis]] are more prone to develop [[SBP]] irrespective of the presence of [[ascites]].
| valign="top" |
* The [[Toll-like receptor 2|Toll-like receptor 2 (TLR2)]] proteins variants of the [[NOD2|NOD2 (nucleotide-binding oligomerisation domain)]] containing gene and [[Farnesoid X receptor|Farnesoid X]] were known to cause [[SBP]].<ref name="pmid21356257">{{cite journal| author=Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F et al.| title=Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis. | journal=J Hepatol | year= 2011 | volume= 55 | issue= 5 | pages= 1010-6 | pmid=21356257 | doi=10.1016/j.jhep.2011.02.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21356257  }} </ref><ref name="pmid20087966">{{cite journal| author=Appenrodt B, Grünhage F, Gentemann MG, Thyssen L, Sauerbruch T, Lammert F| title=Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis. | journal=Hepatology | year= 2010 | volume= 51 | issue= 4 | pages= 1327-33 | pmid=20087966 | doi=10.1002/hep.23440 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20087966  }} </ref>
| valign="top" |
* [[Proton pump inhibitors]] (PPI) are associated with a  three-fold increase in the risk and identified as an independent risk factor for [[SBP]] in patients with advanced cirrhosis. <ref name="DamVilstrup2016">{{cite journal|last1=Dam|first1=Gitte|last2=Vilstrup|first2=Hendrik|last3=Watson|first3=Hugh|last4=Jepsen|first4=Peter|title=Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites|journal=Hepatology|volume=64|issue=4|year=2016|pages=1265–1272|issn=02709139|doi=10.1002/hep.28737}}</ref>
* [[Beta-adrenergic antagonists]] namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.
|}


== References ==
== References ==
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[[Category:Gastroenterology]]
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Latest revision as of 00:15, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2] Ahmed Younes M.B.B.CH [3]

Overview

Common risk factors in cirrhotic patients with ascites include: low protein level in ascitic fluid (<1 g/dL), upper GI bleeding, low complement concentration (complement 3) in ascitic fluid, renal failure, elevated serum bilirubin level (>4 mg/dL), use of proton pump inhibitors (PPI) in cirrhotic patients have an increased risk, Child-Pugh stage C, Model For End-Stage Liver Disease (MELD) ≥ 22.

Risk Factors

Risk factors include:[1]

Factors contributing to the infection include:

Risk Factors for SBP
Biochemical Clinical Genetic Pharmacological

Well-established risk factors for developing an initial episode of SBP are :

  • Proton pump inhibitors (PPI) are associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis. [8]

References

  1. Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
  2. 2.0 2.1 Andreu M, Sola R, Sitges-Serra A, Alia C, Gallen M, Vila MC; et al. (1993). "Risk factors for spontaneous bacterial peritonitis in cirrhotic patients with ascites". Gastroenterology. 104 (4): 1133–8. PMID 8462803.
  3. 3.0 3.1 3.2 Mustafa MG, Al Mamun MA, Alam AK (2009). "Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis". Bangladesh Med Res Counc Bull. 35 (2): 41–3. PMID 20120777.
  4. van Erpecum KJ (2006). "Ascites and spontaneous bacterial peritonitis in patients with liver cirrhosis". Scand. J. Gastroenterol. Suppl. (243): 79–84. doi:10.1080/00365520600664342. PMID 16782626.
  5. Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M; et al. (2014). "Nonselective β blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis". Gastroenterology. 146 (7): 1680–90.e1. doi:10.1053/j.gastro.2014.03.005. PMID 24631577.
  6. Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F; et al. (2011). "Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis". J Hepatol. 55 (5): 1010–6. doi:10.1016/j.jhep.2011.02.022. PMID 21356257.
  7. Appenrodt B, Grünhage F, Gentemann MG, Thyssen L, Sauerbruch T, Lammert F (2010). "Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis". Hepatology. 51 (4): 1327–33. doi:10.1002/hep.23440. PMID 20087966.
  8. Dam, Gitte; Vilstrup, Hendrik; Watson, Hugh; Jepsen, Peter (2016). "Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites". Hepatology. 64 (4): 1265–1272. doi:10.1002/hep.28737. ISSN 0270-9139.

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