Spontaneous bacterial peritonitis natural history
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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] Shivani Chaparala M.B.B.S [3]
Overview
SBP is common and indicates a poor prognosis.
Natural History , Complications and Prognosis
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: Cardiac ascites, nephrogenic ascites, ascites associated with fulminant hepatic failure, malignant ascites, and alcoholic and viral hepatitis. 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
- 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.[1]
Complications
Prognosis
- The prognosis of SBP has improved dramatically since its first description. [1]
- 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. [2]
- The grave prognosis associated with a diagnosis of SBP in in-patients may not be applicable to outpatients with neutrocytic ascites.[3]
References
- ↑ 1.0 1.1 Sheer TA, Runyon BA (2005). "Spontaneous bacterial peritonitis". Dig Dis. 23 (1): 39–46. doi:10.1159/000084724. PMID 15920324.
- ↑ Tandon P, Garcia-Tsao G (2011). "Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis". Clin. Gastroenterol. Hepatol. 9 (3): 260–5. doi:10.1016/j.cgh.2010.11.038. PMID 21145427. Unknown parameter
|month=ignored (help) - ↑ Evans LT, Kim WR, Poterucha JJ, Kamath PS (2003). "Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites". Hepatology. 37 (4): 897–901. doi:10.1053/jhep.2003.50119. PMID 12668984.