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Abstract：
OBJECTIVE: To investigate the survival outcomes and risk factors for mortality in cirrhotic patients with probable spontaneous bacterial peritonitis (SBP).
METHODS: We retrospectively analyzed the clinical data of 323 cirrhotic patients with ascites admitted from June 2021 to May 2022, including 115 patients with SBP [ascites polymorphonuclear leucocyte (PMN) count ≥250/mm3], 52 patients with bacterascites (PMN count < 250/mm3 with positive microbiological finding in ascites), 67 patients with probable SBP (PMN count < 250/mm3 with negative microbiological finding in ascites but clinical symptoms of SBP) and 89 patients without infection (PMN count < 250/mm3 with negative microbiological finding without clinical symptoms of SBP). The clinical characteristics, laboratory data and 90-day mortality of the patients were compared among the 4 groups. Cox proportional hazard model and propensity score matching (PSM) in a 1∶1 ratio were used to analyze the risk factors for mortality in patients with probable SBP.
RESULTS: The patients with probable SBP had a 90-day mortality rate of 43.28%, similar to those of patients with SBP (46.95%, P=0.121) and bacterascites (48.07%, P=0.805) but significantly higher than that of non-infected patients (11.23%, P < 0.001). In the 46 pairs of patients matched using PSM, the 90-day mortality rates were higher in probable SBP group than in non-infected group both before (43.28% vs 11.23%, P < 0.001) and after PSM (34.78% vs 15.21%, P=0.038). Cox regression analysis indicated that probable SBP was an independent predictor of 90-day mortality in cirrhotic patients with ascites (HR=1.539, 95% CI: 1.048-2.261, P=0.028). A Model for End-Stage Liver Disease (MELD) score > 15 (HR=1.943, 95% CI: 1.118-3.377, P=0.018) and procalcitonin level > 0.48 ng/mL (HR=1.989, 95% CI: 1.111-3.560, P=0.021) at diagnostic paracentesis were both independent risk factors for 90-day mortality in patients with probable SBP.
CONCLUSIONS: Cirrhotic patients with probable SBP have poor survival outcomes, and their management should be further optimized based on their MELD score and procalcitonin level.
METHODS: We retrospectively analyzed the clinical data of 323 cirrhotic patients with ascites admitted from June 2021 to May 2022, including 115 patients with SBP [ascites polymorphonuclear leucocyte (PMN) count ≥250/mm3], 52 patients with bacterascites (PMN count < 250/mm3 with positive microbiological finding in ascites), 67 patients with probable SBP (PMN count < 250/mm3 with negative microbiological finding in ascites but clinical symptoms of SBP) and 89 patients without infection (PMN count < 250/mm3 with negative microbiological finding without clinical symptoms of SBP). The clinical characteristics, laboratory data and 90-day mortality of the patients were compared among the 4 groups. Cox proportional hazard model and propensity score matching (PSM) in a 1∶1 ratio were used to analyze the risk factors for mortality in patients with probable SBP.
RESULTS: The patients with probable SBP had a 90-day mortality rate of 43.28%, similar to those of patients with SBP (46.95%, P=0.121) and bacterascites (48.07%, P=0.805) but significantly higher than that of non-infected patients (11.23%, P < 0.001). In the 46 pairs of patients matched using PSM, the 90-day mortality rates were higher in probable SBP group than in non-infected group both before (43.28% vs 11.23%, P < 0.001) and after PSM (34.78% vs 15.21%, P=0.038). Cox regression analysis indicated that probable SBP was an independent predictor of 90-day mortality in cirrhotic patients with ascites (HR=1.539, 95% CI: 1.048-2.261, P=0.028). A Model for End-Stage Liver Disease (MELD) score > 15 (HR=1.943, 95% CI: 1.118-3.377, P=0.018) and procalcitonin level > 0.48 ng/mL (HR=1.989, 95% CI: 1.111-3.560, P=0.021) at diagnostic paracentesis were both independent risk factors for 90-day mortality in patients with probable SBP.
CONCLUSIONS: Cirrhotic patients with probable SBP have poor survival outcomes, and their management should be further optimized based on their MELD score and procalcitonin level.
摘要：
目的：探讨合并自发性细菌性腹膜炎(SBP)的肝硬化患者的生存结局和死亡危险因素。
方法：我们回顾性分析了2021年6月至2022年5月收治的323例肝硬化腹水患者的临床资料，其中包括115例SBP[腹水多形核白细胞（PMN）计数≥250/mm3]，52例细菌腹水患者（PMN计数<250/mm3，在腹水中发现微生物阳性），67例可能的SBP患者（PMN计数<250/mm3，腹水中微生物学发现阴性，但有SBP的临床症状）和89例无感染患者（PMN计数<250/mm3，微生物学发现阴性，无SBP的临床症状）。临床特点,比较了4组患者的实验室数据和90日死亡率.采用Cox比例风险模型和1∶1比例的倾向评分匹配(PSM)分析可能SBP患者死亡的危险因素。
结果：可能出现SBP的患者90天死亡率为43.28%，与SBP患者相似(46.95%，P=0.121）和腹水（48.07%，P=0.805)但显著高于非感染患者(11.23%,P<0.001)。在使用PSM匹配的46对患者中，可能SBP组的90天死亡率均高于未感染组（43.28％vs11.23％，P<0.001）和PSM后（34.78％vs15.21％，P=0.038)。Cox回归分析显示，可能的SBP是肝硬化腹水患者90天死亡率的独立预测因素（HR=1.539，95％CI：1.048-2.261，P=0.028）。终末期肝病模型（MELD）评分>15（HR=1.943，95％CI：1.118-3.377，P=0.018）和降钙素原水平>0.48ng/mL（HR=1.989，95％CI：1.111-3.560，P=0.021）是可能SBP患者90天死亡率的独立危险因素。
结论：伴可能SBP的肝硬化患者生存结局较差，应根据MELD评分和降钙素原水平进一步优化管理.
方法：我们回顾性分析了2021年6月至2022年5月收治的323例肝硬化腹水患者的临床资料，其中包括115例SBP[腹水多形核白细胞（PMN）计数≥250/mm3]，52例细菌腹水患者（PMN计数<250/mm3，在腹水中发现微生物阳性），67例可能的SBP患者（PMN计数<250/mm3，腹水中微生物学发现阴性，但有SBP的临床症状）和89例无感染患者（PMN计数<250/mm3，微生物学发现阴性，无SBP的临床症状）。临床特点,比较了4组患者的实验室数据和90日死亡率.采用Cox比例风险模型和1∶1比例的倾向评分匹配(PSM)分析可能SBP患者死亡的危险因素。
结果：可能出现SBP的患者90天死亡率为43.28%，与SBP患者相似(46.95%，P=0.121）和腹水（48.07%，P=0.805)但显著高于非感染患者(11.23%,P<0.001)。在使用PSM匹配的46对患者中，可能SBP组的90天死亡率均高于未感染组（43.28％vs11.23％，P<0.001）和PSM后（34.78％vs15.21％，P=0.038)。Cox回归分析显示，可能的SBP是肝硬化腹水患者90天死亡率的独立预测因素（HR=1.539，95％CI：1.048-2.261，P=0.028）。终末期肝病模型（MELD）评分>15（HR=1.943，95％CI：1.118-3.377，P=0.018）和降钙素原水平>0.48ng/mL（HR=1.989，95％CI：1.111-3.560，P=0.021）是可能SBP患者90天死亡率的独立危险因素。
结论：伴可能SBP的肝硬化患者生存结局较差，应根据MELD评分和降钙素原水平进一步优化管理.
