Spontaneous bacterial peritonitis natural history: Difference between revisions

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Latest revision as of 00:15, 30 July 2020

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

Early diagnosis and initiating treatment is the most important factor for improving the survival and avoiding the complications of SBP. The sooner the diagnosis, the better the outcome.

Natural history

SBP is treatable with antibiotics but early diagnosis and intiation of empiric antibiotic therapy is the most important factor for survival.
In a study performed in 2006, Each hour of delay of administration of empiric antibiotics was associated with increased mortality by 7.6% while administration of antibiotics at the first hour of hypotension increased overall survival to 79%.^[1]

Complications

The physician should have a high index of suspicion to diagnose SBP early and start empiric antibiotic therapy. The earlier the stage of diagnosis, the better the survival.

Hypotension, hypothermia and shock:

With the progression of infection, septicaemia ensues with its classic symptoms and signs. Septicaemia and shock are associated with very bad prognosis.

Altered mental status:

Hepatic decompensation in association with the progression of infection make altered mental status more likely to happen. Ammonia levels can be within normal limits or slightly elevated as hepatic decompensation is not the only element leading to the altered mental status.

Paralytic ileus:

Peritoneal inflammation can be complicated with paralytic ileus. Paralytic ileus is a very poor prognostic sign with increased mortality rate.

Diarrhea:

Diarrhea is common due to associated intestinal bacterial overgrowth.^[2]

Prognosis

Mortality of SBP remains high. 1-year mortality rate is 30-90% ^[3], probably due to the advanced liver disease present in the first place.
Early admission and prophylactic cephalosporins might have a role in decreasing mortality rate.^[4]

References

↑ Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M (2006). "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock". Crit. Care Med. 34 (6): 1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PMID 16625125.
↑ Guarner C, Runyon BA, Young S, Heck M, Sheikh MY (1997). "Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites". J. Hepatol. 26 (6): 1372–8. PMID 9210626.
↑ Sundaram V, Manne V, Al-Osaimi AM (2014). "Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers". Saudi J Gastroenterol. 20 (5): 279–87. doi:10.4103/1319-3767.141686. PMC 4196342. PMID 25253362.
↑ "Spontaneous bacterial peritonis - ScienceDirect".

[pmid16625125-1] Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M (2006). "Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock". Crit. Care Med. 34 (6): 1589–96. doi:10.1097/01.CCM.0000217961.75225.E9. PMID 16625125.

[pmid9210626-2] Guarner C, Runyon BA, Young S, Heck M, Sheikh MY (1997). "Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites". J. Hepatol. 26 (6): 1372–8. PMID 9210626.

[pmid25253362-3] Sundaram V, Manne V, Al-Osaimi AM (2014). "Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers". Saudi J Gastroenterol. 20 (5): 279–87. doi:10.4103/1319-3767.141686. PMC 4196342. PMID 25253362.

[urlSpontaneous_bacterial_peritonis_-_ScienceDirect-4] "Spontaneous bacterial peritonis - ScienceDirect".

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Spontaneous bacterial peritonitis}}
-{{CMG}} ; {{AE}} {{ADI}}
+{{CMG}} ; {{AE}}{{SCh}} {{AY}}
 ==Overview==
-SBP is common and indicates a poor prognosis.
+Early diagnosis and initiating treatment is the most important factor for improving the [[Survival rate|survival]] and avoiding the complications of SBP. The sooner the diagnosis, the better the outcome.
-==Natural History , Complications and Prognosis==
+==Natural history==
-Spontaneous bacterial peritonitis (SBP) is a potentially fatal yet reversible cause of deterioration in patients with decompensated cirrhosis. SBP developing in the setting of ascites from causes other than cirrhosis is rare, but can occur in:
+*SBP is treatable with [[antibiotics]] but early diagnosis and intiation of [[Antibiotic therapy|empiric antibiotic therapy]] is the most important factor for survival.
-Cardiac ascites, nephrogenic ascites, ascites associated with fulminant hepatic failure, malignant ascites, and alcoholic and viral hepatitis.
+*In a study performed in 2006, Each hour of delay of administration of empiric antibiotics was associated with increased [[Mortality rate|mortality]] by 7.6% while administration of [[antibiotics]] at the first hour of [[hypotension]] increased overall survival to 79%.<ref name="pmid16625125">{{cite journal |vauthors=Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M |title=Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock |journal=Crit. Care Med. |volume=34 |issue=6 |pages=1589–96 |year=2006 |pmid=16625125 |doi=10.1097/01.CCM.0000217961.75225.E9 |url=}}</ref>
-[[Spontaneous bacterial peritonitis]] presents as a complication of [[ascites]]  which can be due to [[cirrhosis]] , [[heart failure]] or [[renal failure]]. Untreated disease leads to complications and has a poor prognosis. Uncomplicated SBP is defined as spontaneous bacterial peritonitis in the absence of shock, hemorrhage, ileus, severe renal failure and severe encephalopathy.
-===Natural History===
+==Complications==
-* SBP has evolved from a universally fatal disease to a reversible and even preventable cause of deterioration or death in a patient with advanced cirrhosis.<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>
+The physician should have a high index of suspicion to diagnose SBP early and start empiric antibiotic therapy. The earlier the stage of diagnosis, the better the survival.
+===Hypotension, hypothermia and shock:===
+*With the progression of [[infection]], [[septicaemia]] ensues with its classic symptoms and signs. [[Septicaemia]] and [[shock]] are associated with very bad prognosis.
+===Altered mental status:===
+*[[Liver diseases|Hepatic decompensation]] in association with the progression of [[infection]] make [[altered mental status]] more likely to happen. [[Ammonia]] levels can be within normal limits or slightly elevated as [[Liver diseases|hepatic decompensation]] is not the only element leading to the [[altered mental status]].
+===Paralytic ileus:===
+*[[Peritonitis|Peritoneal inflammation]] can be complicated with [[paralytic ileus]]. [[Paralytic ileus]] is a very poor prognostic sign with increased [[mortality rate]].
+===Diarrhea:===
+*[[Diarrhea]] is common due to associated [[Bacterial overgrowth|intestinal bacterial overgrowth]].<ref name="pmid9210626">{{cite journal |vauthors=Guarner C, Runyon BA, Young S, Heck M, Sheikh MY |title=Intestinal bacterial overgrowth and bacterial translocation in cirrhotic rats with ascites |journal=J. Hepatol. |volume=26 |issue=6 |pages=1372–8 |year=1997 |pmid=9210626 |doi= |url=}}</ref>
-===Complications===
+==Prognosis==
-* [[Sepsis]]
-* [[Encephalopathy]]
-* [[Liver failure]]
-* [[Renal failure]]
-* Tense [[ascites]]
-* [[Coma]]
-* [[Death]]
-===Prognosis===
+*[[Mortality rate|Mortality]] of SBP remains high. 1-year [[mortality rate]] is 30-90% <ref name="pmid25253362">{{cite journal |vauthors=Sundaram V, Manne V, Al-Osaimi AM |title=Ascites and spontaneous bacterial peritonitis: recommendations from two United States centers |journal=Saudi J Gastroenterol |volume=20 |issue=5 |pages=279–87 |year=2014 |pmid=25253362 |pmc=4196342 |doi=10.4103/1319-3767.141686 |url=}}</ref>, probably due to the advanced [[Liver diseases|liver disease]] present in the first place.
-* The prognosis of SBP has improved dramatically since its first description. <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>
+*Early admission and [[Cephalosporins|prophylactic cephalosporins]] might have a role in decreasing [[mortality rate]].<ref name="urlSpontaneous bacterial peritonis - ScienceDirect">{{cite web |url=http://www.sciencedirect.com/science/article/pii/0011502985900021?via%3Dihub |title=Spontaneous bacterial peritonis - ScienceDirect |format= |work= |accessdate=}}</ref>
-* Inpatient mortality has declined from 100% in the 1960s to 60–70% in the 1970s and 1980s to 30% or less in studies performed in the past 10 years. This is likely due to earlier detection and effective, nontoxic therapy.
-* Approximately half of all deaths in patients with SBP occur after resolution of the infection and are from gastrointestinal hemorrhage or liver or renal failure.
-* One study showed an overall mortality of 37.8% in patients admitted with SBP, but only 2.2% were directly attributable to infection
-* The presence of renal insufficiency is the strongest independent prognostic indicator, but the presence of peripheral leukocytosis, older age, higher Child-Pugh score, and the presence of an ileus have also been shown to predict inpatient mortality. Patients with hospital versus community-acquired SBP also appear to have a higher mortality.
-* Patients surviving an episode of SBP should be considered for liver transplantation if acceptable.The use of selective intestinal decontamination (SID) with norfloxacin in patients admitted to the hospital with low-protein ascites has also shown a reduction in the incidence of SBP from 22.5 to 0%
-[[Renal dysfunction]] is an important prognostic indicator followed by the [[Model for End-Stage Liver Disease]] (MELD) score. With an increase of [[MELD score]] prognosis becomes worse. <ref name="pmid21145427">{{cite journal |author=Tandon P, Garcia-Tsao G |title=Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis |journal=Clin. Gastroenterol. Hepatol. |volume=9 |issue=3 |pages=260–5 |year=2011 |month=March |pmid=21145427 |doi=10.1016/j.cgh.2010.11.038 |url=}}</ref>
-* The grave prognosis associated with a diagnosis of SBP in in-patients may not be applicable to outpatients with neutrocytic ascites.<ref name="pmid12668984">{{cite journal| author=Evans LT, Kim WR, Poterucha JJ, Kamath PS| title=Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. | journal=Hepatology | year= 2003 | volume= 37 | issue= 4 | pages= 897-901 | pmid=12668984 | doi=10.1053/jhep.2003.50119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12668984  }} </ref>
 ==References==
 {{reflist|2}}
-{{WH}}
-{{WS}}
 [[Category:Gastroenterology]]
 [[Category:Emergency medicine]]
+[[Category:Emergency mdicine]]
+[[Category:Disease]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]