Predictors of 50 Day In-Hospital Mortality in Decompensated Cirrhosis Patients with Spontaneous Bacterial Peritonitis

Aim : Predictors of 50 day in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis (SBP). Methods : 218 SBP patients admitted to intensive care units in a tertiary care hospital were retrospectively analyzed. Student t test, multivariate logistic regression, Cox pro portional hazard ratio, receiver operating characteristics curves and Kaplan-Meier sur - vival analysis were utilized for statistical analysis. Predictive powers of the statistical significant variables were compared using the area under receiver operating characteris - tics curve (AUC). p values <0.05 were considered statistical significant. Results : SBP related in-hospital mortality rate was 43%. Multivariate regression analysis showed acute kidney injury, hepatic encephalopathy, positive ascitic culture, leucocyte count, bilirubin, serum glutamic oxaloacetic transaminase (SGOT), Child Pugh score, and Model for End stage Liver Disease Sodium (MELD-Na) were significantly associ ated with 50 day in-hospital mortality. The prognostic accuracy for acute kidney injury, MELD-Na and septic shock was 77, 74 and 71% respectively. Conclusion : Acute kidney injury, MELD-Na and septic shock were predictors of 50 day in-hospital mortality in decompensated cirrhotic patients with SBP. disease, laboratory parameters, co-existing medi cal conditions (diabetes mellitus, hepatocellular carcinoma), previous medication use, organ failure, ascitic fluid analysis results, duration of ICU stay, and patient outcome. In culture-positive cases growth of the organisms and antibiotic sensitivity were recorded. MELD-Na score was based on laboratory parameters (bilirubin, creatinine levels and INR) collected at admission and determined by using the Internet site MELD calculator [ 12]. Diagnostic ascitic tapping was done upon admission to ICU in all patients with ascites except in those with severe coagulopathy. Ascitic fluid was sent for differential cell count and cul -ture. Blood sample was also sent for culture at admission in all patients. Antibiotics adminis tered in patients based on previous antibiotic exposure and based on culture and sensitivity. Our study demonstrated that AKI has the single best predictive ability (AUC = 0.77) followed by MELD-Na (AUC = 0.74) and septic shock (AUC = 0.71). We set a cut-off value for MELD-Na to be 28. It has sensitivity 92.9% and NPV of 97.9%. AKI has the highest hazards of mortal ity (HR 2.16, 95% CI 1.36–3.42) followed by septic shock (HR 1.73, 95% CI 1.05–2.83) and MELD-Na (HR 1.06, 95% 1.02–1.09). We plotted graph of Kaplan-Meier survival analysis. The graph illustrated AKI, MELD-Na, and septic shock as predictors for the 50 day in-hospital mortality in decompensated patients with SBP. We hope that these prognostic variables can help in the further improvement of the quality of care of hospitalized SBP patients. The cut-off value 28 for MELD-Na can be utilized to stratify patients diagnosed with SBP into high risk category upon hospital admission. our patients according to different stages of AKI as per AKIN criteria. We did not take HRS into account in our study. The standard first line antibiotics were not used in the treatment of SBP. The choice of antibiotics coverage based of culture sensitivity and previous exposure. We did not thoroughly evaluate the antibiotic resistance in SBP patients who are culture positive at the baseline. We included only nosocomial acquired SBP. Most of our patients presented with advanced decompensated liver cirrhosis at the time of SBP diagnosis as it is a tertiary care center. The advanced liver cirrhosis was assessed by lower serum albumin, high serum biliru bin and INR values. As an observational study we were unable to assess the impact of volume expansion and SBP specific therapy on patient outcome. Our study is a single center study, these findings needed to be supplemented by multicenter prospective studies. Our study findings can guide in advanced liver cirrhosis patients that would benefit them from intensive management where liver transplant is not feasible.