| Objective: To explore the clinical characteristics and risk factors of cirrhotic ascites complicated by spontaneous bacterial peritonitis(SBP)and analyze the prognosis of cirrhotic ascites,which will provide basis for the clinical diagnosis,prevention and treatment of cirrhotic ascites.Methods: A total of 434 patients with cirrhotic ascites hospitalized in the First Affiliatded Hospital from January 2017 to December 2020 were enrolled in this study.The clinical data of all patients including general information,clinical manifestations,laboratory tests and survival data were collected.Among of the 434 patients,23 patients whose ascites samples were detected by Next-generation sequencing(NGS)for pathogenic detection were divided into two groups: the NGS-negative group was defined as no pathogens or pathogens such as viruses and fungi detected in ascites samples,and the NGS-positive group was defined as bacteria detected in ascites samples.The etiological characteristics of ascites and its correlation with Serum ascites albumin gradient(SAAG)were analyzed.A total of 281 patients with SBP were included in the SBP group,and 153 patients without SBP were included in the non-SBP group.The factors that may affect the occurrence of SBP were analyzed by single factor analysis,and the corresponding independent risk factors were further screened out by multivariate logistic regression model.Then ROC curve was used to obtain the optimal critical value and predictive value of independent risk factors.A total of 81 patients who were discharged automatically or died were included in the poor prognosis group,and 353 patients with improved condition were included in the good prognosis group.The same method was use to screened out the independent prognosis risk factors and to obtain the optimal critical value and predictive value.Results: 1.Among the 153 patients with liver cirrhosis and ascites with a clear diagnosis of SBP,31 of them were positive for bacterial culture in ascites,with a positive rate of 20.26%;23 of 434 cases were tested for NGS pathogens,and 14 of them were tested positive for ascites,with a positive rate of 60.87%.The level of SAAG in NGS-positive group was significantly higher than that in NGS-negative group(P<0.05).2.Age,fever,hepatic encephalopathy,hepatorenal syndrome,upper gastrointestinal bleeding,child-Pugh score,serum WBC,serum PLT,serum ALB,serum GLB,serum TBIL,PT,ascites ALB,PCT,SAAG were significantly correlated with cirrhotic ascites complicated with SBP(all P<0.05).Hepatorenal syndrome,increased serum TBil level,decreased serum ALB level,increased serum PCT level decreased ascites ALB level and increased SAAG level were independent risk factors for the occurrence of SBP in patients with cirrhotic ascites(all P<0.05),and the accuracy were respectively at 0.851 and 0.827 when serum TBIL > 50.1umol/ L,SAAG > 22.7g/L(all P < 0.05).3.Age,diarrhea,abdominal pain,hepatic encephalopathy,upper gastrointestinal hemorrhage,hepatorenal syndrome,child-Pugh score,serum WBC,serum PLT,serum ALB,serum GLB,serum TBIL,PT,serum Cr,SAAG,PCT were significantly correlated with the prognosis of cirrhosis ascites(all P < 0.05).Decreased serum ALB level,decreased serum GLB level,increased serum TBIL level and increased SAAG level were independent risk factors for the poor prognosis of cirrhosis ascites,and the accuracy were respectively at 0.803,0.801,0.897 when serum ALB≤29.4g/ L,serum GLB≤28.3g/ L,and SAAG >19.9g/ L(All P < 0.05).Conclusion: 1.Serum TBIL>50.1umol/L and SAAG>22.7g/L are favorable for predicting cirrhotic ascites complicated with SBP.Attention should be paid to these indicators to prevent the occurrence of SBP and provide early intervention.2.Serum ALB≤29.4g/l,serum GLB≤28.3g/l and SAAG>19.9g/L are favorable for predicting the poor prognosis of cirrhotic ascites,and early treatment should be provided for such patients to improve their prognosis.3.NGS based pathogen detection has a high positive rate for diagnosing SBP and has great clinical value. |
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