Predictive Factors That Influence The Survival In Liver Cirrhosis Patients With Spontaneous Bacterial Peritonitis

Objective:Spontaneous bacterial peritonitis is a commoncomplication of decompensated cirrhosis,which greatly influence thesurvival rate of patients with liver cirrhosis.The mortality of SBP is about20-40%, although the prognosis has been improved with the improvementof early diagnosis and empirical antimicrobial therapy.Identification ofpatients that are at high risk for mortality in SBP is critical forprognostic improvement.The relationship between the cultured bacteriaspecies and the clinical outcome of the SBP patients is still not very clear.The aim of this study is to investigate predictive factors for survival ratein liver cirrhosis patients with SBP,which is helpful to assess and improvethe knowledge of this disease and the prognosis of SBP patients.Methods: We collected the clinical records of liver cirrhosis patientswith SBP admitted in the first hospital of Jilin university between January2013and January2014,then followed up them between April2013andJanuary2015.All analyses were performed using SPSS version19.0.Wecalculated cumulative survival rates by using Kaplan-Meier analysis andthe difference was determined by the log-rank test. In order to find thepredictors for survival, multivariate analysis using a proportional hazardsCox regression model was performed. Gender,age,cause of liver cirrhosis,the presence or absence of diabetes,Child-Pugh grade, MELD(model forend-stage liver disease)score, serum laboratory findings including bilirubin,ALT,serum prothrombin time (INR),serum creatinine,thepresence of microorganisms,the presence of more than one species ofbacteria,type of isolated microorganisms, Gram stain,multiple resistantbacteria,laboratory findings of ascitic fluid were included in analysis.Results: The number of culture-positive SBP in the133patientswith liver cirrhosis was92(69.2%), E. Coli,Streptococcus andEnterococcus was the most frequently isolated organism. The overallsurvival rates at6,12, and24months were68%，61%，52%, respectively.Gender,age,cause of liver cirrhosis,the complication of diabetes,albuminlevels and glucose in ascitic fluid,the presence of microorganisms andmore than one species of bacteria,type of isolated microorganisms, Gramstain,multiple resistant bacteria,were not related to survival rate inpatients with SBP. Multivariate analysis revealed that higher serumbilirubin levels,higher serum creatinine,lower serum sodium and higherPMN levels were independent predictive factors of overall survival rate.Conclusions: Higher serum bilirubin levels(＞51umol/L),renaldysfunction(serum creatinine＞115umol/L),lower serum sodium （＜130mmol/L）,higer PMN levels（≥1000×106/L） are independentpredictive factors of overall survival rate.