[Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice]. / Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica.

OBJECTIVES: To assess survival and predictive factors of mortality after an episode of spontaneous bacterial peritonitis (SBP) in cirrhotic patients and to analyze the diagnostic and therapeutic measures used. METHODS: We retrospectively reviewed the medical records of 158 consecutive episodes of SBP treated between January 2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independent predictive factors of mortality were obtained by a Cox regression model, while independent predictive factors of in-hospital mortality were obtained by logistic regression analysis. RESULTS: A total of 80.4% of the SBP episodes occurred in men and the mean age was 61.23 +/- 12.49 years. The most frequent etiology of cirrhosis was viral (51.3%), followed by alcoholic (39.9%). The distribution of Child-Pugh classification was 5.7% (A), 63.3% (B) and 31% (C). Overall 3-year survival in the sample was 43.3%. Four variables were identified as independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy, diagnosis of hepatocellular carcinoma (HCC) and mean arterial pressure (MAP) < 75 mmHg. At the end of the monitoring period, the results of the analysis were as follows: diagnosis of HCC, MAP < 75 mmHg, and age > 65 years. Microbiological detection was achieved in 21% of the episodes. The most frequent microorganisms detected were Escherichia coli in ascitic fluid and Staphylococcus aureus in blood cultures. CONCLUSIONS: SBP has a poor short- and long-term prognosis in cirrhotic patients. Independent predictive factors of short-term survival are renal impairment, hepatic encephalopathy, MAP < 75 mmHg, and the presence of HCC.

Valor pronóstico de un episodio de peritonitis bacteriana espontánea en pacientes cirróticos en la práctica clínica / Prognostic value of a spontaneous bacterial peritonitis episode in cirrhotic patients in clinical practice

OBJETIVOS: Evaluar la supervivencia y los factores pronósticotras el diagnóstico de un episodio de peritonitis bacterianaespontánea (PBE) en pacientes cirróticos y las medidasdiagnosticadas y terapéuticas utilizadas.MÉTODOS: Se revisaron de manera retrospectiva los datos de158 episodios de PBE consecutivos durante el período deenero de 2003 a diciembre de 2005. Se procedió a un análisisde supervivencia mediante curvas de Kaplan-Meier, su comparaciónmediante el test de rangos logarítmicos, y valoraciónde los factores predictivos independientes mediante regresiónde Cox, y de mortalidad intrahospitalaria medianteregresión logística.RESULTADOS: El 80,4% de los episodios de PBE se produjoen varones, y la edad media fue de 61,23 ± 12,49 años. Laetiología de la cirrosis más prevalente fue viral (51,3%) seguidadel origen etílico (39,9%), y la distribución según laclasificación de Child-Pugh fue del 5,7% (A), 63,3% (B) y31% (C). La supervivencia global de la cohorte a los 3 añosdel seguimiento fue del 43,3%. Se determinaron como factoresindependientes asociados a mortalidad, tanto intrahospitalariacomo a los 3 meses tras la PBE el deterioro de funciónrenal, la presencia de encefalopatía hepática, laexistencia de carcinoma hepatocelular (CHC) y una presiónarterial media (PAM) < 75 mmHg, y a largo plazo la edad> 65 años, la existencia de CHC y la PAM < 75 mmHg. Seconsiguió el aislamiento microbiológico en el 20,3% de losepisodios. El microorganismo más frecuentemente aisladoen el líquido ascítico fue Escherichia coli y en hemocultivosStaphylococcus aureus.CONCLUSIONES: La PBE es un evento pronóstico importanteen la cirrosis hepática, y los factores independientes de mortalidada corto plazo son el deterioro de función renal, lapresencia de encefalopatía hepática, la existencia de CHC yPAM < 75 mmHg

OBJECTIVES: To assess survival and predictive factors ofmortality after an episode of spontaneous bacterial peritonitis(SBP) in cirrhotic patients and to analyze the diagnosticand therapeutic measures used.METHODS: We retrospectively reviewed the medical recordsof 158 consecutive episodes of SBP treated between January2003 and December 2005. Survival was studied by Kaplan-Meier curves, compared by the log-rank test. Independentpredictive factors of mortality were obtained by a Cox regressionmodel, while independent predictive factors of inhospitalmortality were obtained by logistic regressionanalysis.RESULTS: A total of 80.4% of the SBP episodes occurred inmen and the mean age was 61.23 ± 12.49 years. The mostfrequent etiology of cirrhosis was viral (51.3%), followed byalcoholic (39.9%). The distribution of Child-Pugh classificationwas 5.7% (A), 63.3% (B) and 31% (C). Overall 3-yearsurvival in the sample was 43.3%. Four variables were identifiedas independent predictive factors of in-hospital and 3-month mortality: renal impairment, hepatic encephalopathy,diagnosis of hepatocellular carcinoma (HCC) andmean arterial pressure (MAP) < 75 mmHg. At the end of themonitoring period, the results of the analysis were as follows:diagnosis of HCC, MAP < 75 mmHg, and age > 65 years.Microbiological detection was achieved in 21% of theepisodes. The most frequent microorganisms detected wereEscherichia coli in ascitic fluid and Staphylococcus aureus inblood cultures.CONCLUSIONS: SBP has a poor short- and long-term prognosisin cirrhotic patients. Independent predictive factors ofshort-term survival are renal impairment, hepatic encephalopathy,MAP < 75 mmHg, and the presence of HCC (AU)