Journal Article

Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis

Laser, Hans, Gerbel, Svetlana, Manns, Michael Peter, Kimmann, Markus, Tergast, Tammo Lambert, Schultalbers, Marie, Cornberg, Markus, Maasoumy, Benjamin

2019

Overview

Bacterial infections, in particular a spontaneous bacterial peritonitis (SBP), are a major threat in patients with liver cirrhosis. Recently, it has been shown that the impact on mortality might be underestimated by established risk-scores. Onset of infection was suggested to define a distinct stage of cirrhosis. However, it remains unclear whether all stages of decompensated cirrhosis are equally affected. Moreover, if there is such a distinct stage, it must be determined whether it is reversible after the infection has resolved. In this study we aimed to further analyze the impact of a current as well as a resolved SBP in different stages of decompensated liver cirrhosis. A number of 579 patients with liver cirrhosis and ascites were included. MELD-score was used to determine the stage of liver disease. Low (<15), intermediate (15-25) and high (>25) MELD-groups were compared. Patients were followed up for 90 days. Primary endpoint was overall mortality. Statistical analyses were performed using the log-rank test, Cox regression and competing risk analysis. Mortality was significantly higher in patients with nosocomial-acquired SBP (nSBP) compared to patients without SBP (p<0.001;HR = 2.05). However, the most prominent difference in mortality was documented in the intermediate MELD-group (nSBP: p = 0.02;HR = 2.10). Importantly, mortality in nSBP patients remained increased even after the initial nSBP episode had resolved (p<0.01;HR = 1.90). Again, this was only significant in those with intermediate MELD-scores (p = 0.02;HR = 2.28). While a current as well as a resolved nSBP were significantly linked to a higher mortality, neither of them did increase the likelihood for liver transplantation. Development of nSBP is independently associated with increased mortality supporting the concept of a distinct status of cirrhosis. Importantly, the prognosis remains unfavorable even after resolution of nSBP. This could be particularly relevant for patients with intermediate MELD-scores, who have limited chances for a donor liver.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Antibiotics / Ascites / Bacteria / Bacterial diseases / Bacterial infections / Cirrhosis / Cross Infection - complications / Cross Infection - mortality / Development and progression / End Stage Liver Disease - complications / End Stage Liver Disease - mortality / Endocrinology / Female / Gastroenterology / Health risks / Hepatology / Hospitals / Humans / Impact analysis / Infections / Information management / Liver / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - mortality / Liver diseases / Liver transplantation / Liver transplants / Male / Medical prognosis / Medical research / Medical schools / Medicine and Health Sciences / Middle Aged / Mortality / Nosocomial infection / Nosocomial infections / Peritonitis / Peritonitis - complications / Peritonitis - microbiology / Peritonitis - mortality / Prognosis / Prophylaxis / Rank tests / Regression analysis / Risk analysis / Statistical analysis / Survival Rate / Transplantation / Transplants & implants