Analysis Of Risk Factors And Prognostic Risk Factors For Cirrhotic Ascites Accompanied By Spontaneous Bacterial Peritonitis

Objective: To investigate the risk factors of spontaneous bacterial peritonitis and its prognostic factors,and to provide reference for the clinical diagnosis and treatment of patients with cirrhosis.Methods: We choiced patiences who were first performed abdominal puncture and the first diagnosis of spontaneous peritonitis in the The Second Hospital of Dalian Medical University from 2008.01.01—2019.07.31.A total of 237 patients who were diagnosed with cirrhosis and underwent abdominal puncture for the first time after admission were collected,including 95 patients with diagnosed SBP and 142 patients without diagnosed SBP.Collected the relevant clinical data of these patients and analyzed those factors which may affect the occurrence of SBP by single factor analysis,and then identified independent high-risk factors by multivariate Logistic regression model.Patients who diagnosed SBP for the first time were followed up by telephone or in hospital until the end of the study(study deadline: 2019.07.31).In the end,a total of 17 patients were lost to follow-up,31 survived and 47 died.The clinical data of 78 patients were analyzed by single factor analysis using Kaplain-Meier and Log-Rank test,and the risk factors affecting the survival time and outcome of the patients were obtained.Significant factors were further introduced into the Cox survival model to identify independent risk factors affecting disease prognosis.Results:1.The results of single factor analysis showed that total bilirubin level,serum creatinine,blood sodium,previous history of SBP and combined hepatorenal syndrome are all significantly different between the two groups(P<0.05).Further multivariate Logistic regression model analysis showed that total bilirubin level,combined with hepatorenal syndrome and previous history of SBP are independent risk factors for patients with cirrhotic ascites combined SBP(P=0.038,0.011,0.042).2.Log-rank single factor analysis showed that 9 factors,including hematocrystallin,total bilirubin level,serum albumin level,serum creatinine,blood sodium,prothrombin time activity,whether combined with hepatorenal syndrome,whether,combined with hepatic encephalopathy,and Child-Pugh grading of liver function,were correlated with survival time and outcome of patients(P<0.05).These significant clinical indicators mentioned above were introduced into Cox survival analysis model,and the results showed that the blood sodium,total bilirubin levels,whether combined with hepatorenal syndrome are correlated with survival in SBP patiences(P=0.001,0.004,0.007).Conclusion:1.Hyperbilirubinemia,hepatorenal syndrome and previous history of SBP are independent risk factors for SBP in cirrhosis.Clinical cirrhotic ascites patients should pay attention to monitoring the above indicators,alert to the occurrence of SBP.2.In clinical cases,patients with HB<90g/L?ALB?25g/L?TB>51.3?mol/L?Cr>135?mol/L ? blood sodium?135 mmol/L ? PTA<40% ? combined hepatic encephalopathy,combined hepatorenal syndrome and Child-Pugh grade C of liver function may have poor prognosis.3.The three factors of serum sodium ?135 mmol/L,TBIL>51.3 mol/L and combined hepatorenal syndrome were are risk factors affecting the prognosis of SBP.