Spontaneous bacterial peritonitis risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Common risk factors in the development of spontaneous bacterial peritonitis include

Risk Factors

Risk factors include:[1]

  • All cirrhotic patients with ascites
  • Severe liver disease (Cirrhosis)
  • Additional factors which can further increase susceptibility include:
  • Low protein level in ascitic fluid [2]
  • 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.
  • 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.
  • Low complement concentration (complement 3) in ascitic fluid [2]
  • Renal failure
  • Urinary tract infections
  • Intestinal bacterial overgrowth [3]
Risk Factors for SBP
Biochemical Clinical Genetic Pharmacological
Well-established risk factors for developing an initial episode of SBP are :
  • Low ascitic fluid protein level (<1 g/dL)[2]
  • Elevated serum bilirubin level (>4 mg/dL)
  • Advanced Cirrhosis
  • Low levels of 25-hydroxy vitamin D
  • Serum albumin level <2.85 g/dL
* Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites. * The Toll-like receptor 2 (TLR2) proteins[4] variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP. * Proton pump inhibitors (PPI) has been associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
  • Beta-adrenergic antagonists namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.

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 2.2 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. Unknown parameter |month= ignored (help)
  3. 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.
  4. 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.

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