ABSTRACT
@#ObjectiveTo investigate the risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites, and to establish a predictive model of death within 30 days. MethodsA retrospective analysis was performed for the clinical data of 86 patients with liver cirrhosis and bacterial ascites who were admitted to Beijing Ditan Hospital, Capital Medical University, from January 2012 to April 2018. The patients were followed up for 30 days, and according to their prognosis, they were divided into survival group with 73 patients and death group with 13 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression analysis was used to investigate the influencing factors for death within 30 days in patients with liver cirrhosis and bacterial ascites, and a predictive model was established based on these influencing factors. The area under the receiver operating characteristic curve was used to evaluate the predictive value of each independent influencing factor and the predictive model. ResultsThe multivariate logistic regression analysis showed that there were significant differences between the survival group and the death group in ascites albumin (odds ratio ［OR］=0.615, 95% confidence interval ［CI］: 0.424-0.893, P=0.011), neutrophil-to-lymphocyte ratio (NLR) (OR=1.170, 95%CI: 1.011-1.354, P=0.035), and Model for End-Stage Liver Disease (MELD) score (OR=1.341, 95% CI: 1.111-1.618, P=0.002). A scoring model was established based on the results of the multivariate analysis to predict death within 30 days in patients with liver cirrhosis and bacterial ascites, and based on this model, the patients were divided into high-risk group with death within 30 days (score ≥2 points) and low-risk group with death within 30 days (score ＜2 points). There was a significant difference in mortality rate with 30 days between the two groups (60.0% vs 5.6%, P＜0.001). ConclusionAscites albumin ≤3.5 g/L, NLR ≥6.5, and MELD score ≥20 are independent risk factors for death within 30 days in patients with liver cirrhosis and bacterial ascites. The predictive model established on this basis can effectively evaluate the population at high risk of death within 30 days.
ABSTRACT
Se realizó un estudio descriptivo prospectivo entre febrero de 1993 y marzo de 1994. Se estudiaron 25 pacientes cirróticos (3 de ellos en dos ocasiones) con ascitis clínica o ecográfica que ingresaron al servicio de Medicina Interna del Hospital Universitario San Vicente de Paúl, Medellín, Colombia, por descompensación de su cuadro clínico. A todos se les practicó paracentesis diagnóstica con estudio de citoquímico, citología y cultivo para bacterias aerobias y anaerobias. La edad promedio de los pacientes fue de 43.9 años (13 a 77 años), 13 fueron mujeres (52 por ciento) y 12 hombres (48 por ciento). En 11 episodios (39.3 por ciento) se encontró ascitis infectada, así: ascitis bacteriana 6 casos (54.6por ciento) (monomicrobiana en tres y polimicrobiana en otros tres); peritonitis bacteriana espontánea 3 casos (27.2 por ciento) (polimicrobiana en dos y monomicrobiana en uno) y ascitis neutrofílica dos casos (18.2 por ciento). El 72.7 por ciento de los casos con ascitis infectada tuvieron fiebre contra un 23.5 por ciento de aquéllos sin infección (p < 0.014). Asimismo, el dolor abdominal fue un síntoma bastante frecuente (45.5 por ciento) de infección. La ascitis infectada se presentó únicamente en individuos categoría C de la clasificación de Child-Pugh, con niveles séricos de albúmina, generalmente menores de 2 g/dl (p < 0.01). Los niveles de albúmina en líquido ascítico menores de 1 g/dl no se asociaron a la infección del mismo. Los gérmenes prevalentes fueron Escherichia coli y estreptococos del grupo viridans, cada uno aislado en 5 ocasiones. Los aislamientos fueron polimicrobianos en 5 de nueve casos (55.5 por ciento). La mortalidad por ascitis infectada fue de 27.3 por ciento (3/11 casos) comparable con la debida a causas diferentes (29.4 por ciento) en individuos con ascitis sin infección (5/17). Se concluye que la infección del líquido ascítico es una complicación frecuente en los pacientes cirróticos descompensados. La fiebre y el dolor abdominal son los signos clínicos cardinales de la infección. El aislamiento frecuente de E. coli y estreptococos del grupo viridans debe tenerse en cuenta para la adecuada selección de la terapia empírica antibacteriana.
Between February 1993 and March 1994 a prospective descriptive study was carried out in 25 cirrhotic patients (three of them on two occasions) with clinical or ultrasonographic ascites; they were hospitalized in the Internal Medicine ward of San Vicente de Paúl Hospital, in Medellín, Colombia, because of decompensation. All of them went through diagnostic paracentesis with cytologic, bacteriologic and chemical studies. Average age was 43.9 years (13 to 77 years), 13 were women (52%) and 12 men (48%). Infection of the ascitic fluid was found in 11 cases (39.3%), namely: Bacterascites 6 cases (monomicrobial 3 cases (27.3%), polymicrobial 3 cases (27.3%¼, spontaneous bacterial peritonitis 3 cases (polymicrobial 2 cases (18.2%) and monomicrobial1 case (9.1 %¼) and neutrocytic ascites 2 cases (18.2%). Seventy two percent of the infectious episodes caused fever (p < 0.01) and in 46% there was abdominal pain (p < 0.1). AII patients with infected ascites belonged to Child's classification C. Serum albumin levellower than 2 g/dl was a risk factor for developing infection. Escherichia coli was cultivated on 5 occasions (45.5%), viridans group of Streptococci in 5 (45.5%), anaerobes in 3 (27.3%) and other bacteria in 3 (27.3%). Mortality due to infected ascites was 27.3% (3 cases), comparable to that produced by other causes that was 29.4% (5/17). We conclude that ascitic fluid infection is a common complication in decompensated cirrhotic patients. Thecardinal clinical signs are fever and abdominal pain. The frequent isolation of E. coli and viridans group Streptococci has to be taken into account for the initiation of antibiotic therapy in cases with clinical suspicion