Mortality Related Factors in Patients with Spontaneous Bacterial Peritonitis

Spontaneous Bacterial Peritonitis (SBP) is still an important complication of liver cirrhosis with ascites. Although new developments occurred it has a high mortality rate. In order to identify the related factors of mortality in cirrhotics with SBP, we studied 48 patients who fulfilled the accepted diagnostic criteria. All cases were treated with cefotaxime. The resolution rate was 87% in the study group. Eleven patients (22%) died in hospital. The major causes of death were hepatorenal syndrome (HRS) in 4 (36%) and variceal bleeding in 3 (27%). Fifty parameters were studied to find the correlation. Sixteen parameters (urea, bilirubin, MELD score, CTP score, prothrombin time, INR, AST, ALT, PMNL in ascites, systolic and diastolic arterial tension, sepsis, variceal bleeding, changes in mental status, HRS, culture positivity in ascites) were significantly correlated with mortality. Except for bilirubin, INR, AST and PMNL in ascites, the remaining parameters were also found to be predictive in logistic regression analysis. In multivariant analysis, we found that MELD score, INR, ALT, presence of mental change on admission and low mean arterial tension was significantly reduced the resolution of infection. We conclude that mortality in SBP patients mostly depends on the existence of recent variceal bleeding and the degree of liver and renal failure. Strict measures should be taken in cases with variceal bleeding and hepatorenal syndrome.