RESUMEN
Introduction: Spontaneous bacterial peritonitis [SBP] is a frequent and life threatening complication ofcirrhosis. Several large studies have identified additional risk factors for the development ofSBP. Zinc deficiency has been found to be frequent in cirrhotic patients
Aim of the work: The aim of the present study was to evaluate the frequency, possible risk factors and the roleof zinc in the development of first time and recurrent SBP
Methodology:A total of 176 cirrhotic ascetic patients admitted to the Hepatology Department in Sohag University Hospital were enroled in the study. SBP peritonitis was diagnosed throughhistory?taking and through examination and laboratory investigations, including ascetic fluidstudy and the detection of serum zinc level
Results: Of the 176 cirrhotic patients, SBP was diagnosed in 54 [31%]; in total, 40 patients [23%] had single and 14 [8%] had recurrent episodes of SBP. Out of the 23 studied clinical and laboratory variables, we found that the prolonged use of proton pump inhibitor [PPI][P = 0.001],lower prothrombin concentration [P = 0.03], ascetic protein level less than or equal to1 g/dl [P < 0.0001] and zinc deficiency [P = 0.001] were independent risk factors for the development of SBP in cirrhotic patients; using multivariate analysis, only low protein in ascites less than or equal to 1 and low zinc status were predictors of SBP
Conclusion: In our study, the frequency of SBP was 31%; overall, 23% of the patients had first?episodeand 8% had recurrent SBP. The use of PPI, low platelet count, ascetic protein content andzinc deficiency were the predictors for the development of SBP; only low protein in ascites less than or equal to 1 and low zinc status were independent predictors of SBP
RESUMEN
Variceal bleeding is a severe complication in patients with portal hypertension. Early rebleeding occurs frequently in the first few weeks after band ligation, and the mortality associated with each bleeding episode ranges from 30% to 50%. Our aims were to study the rate of early rebleeding oesophageal varices after band ligation in the Sohag University Hospital, Egypt, and to assess different clinical, biochemical, ultrasonographic, and endoscopic parameters that may predict the risk factors of rebleeding. In the period from December 2011 to December 2012, we performed endoscopic variceal ligation [EVL] for 146 cirrhotic patients [105 male and 41 female] with a mean age of 51.77 +/- 10.47 years; the patients were divided into rebleeding and non-rebleeding groups. Complete history taking, clinical examination, laboratory investigations, abdominal ultrasound [US], and upper gastrointestinal [GI] endoscopy were performed for all patients. The incidence of early rebleeding after EVL was 20.54%, and it was significantly associated with male gender [p = 0.013], older age [p = 0.009], infection with spontaneous bacterial peritonitis [SBP] [p < 0.0007], reduced liver size [p = 0.017], a coarser echo pattern [p = 0.03], the presence of hepatic focal lesions [p < 0.001], splenomegaly [p = 0.02], the presence of portosystemic collaterals [p = 0.006], a low haemoglobin [HB] level [p < 0.0001], prothrombin concentration [p = 0.017], high aspartate aminotransferase [AST] level [p = 0.01], Child-Pugh B and C [p = 0.02, 0.003], large oesophageal varices F3 in the two endoscopies [p = 0.002; p < 0.0001], varices extending to the superior third Ls [p < 0.001], and the presence of massive red colour signs [RC+++] [p < 0.0001]. By multivariate analysis, SBP and low HB level were found to be independent predictors of rebleeding. The following conclusions were drawn from this study: [1] The incidence of rebleeding after EVL in our centre is about 20%. [2] Early rebleeding after EVL is affected by many clinical, laboratory, ultrasonographic, and endoscopic parameters. The most prominent of them are SBP, splenomegaly, the presence of collaterals, anaemia, more decompensated cirrhosis, and the presence of large varices with red signs. [3] SBP and low HB level were found to be independent predictors of rebleeding