| Background. Spontaneous bacterial peritonitis (SBP) frequently occurs in hospitalized patients with cirrhosis and ascites and is associated with high mortality. Early paracentesis (EP) allows rapid diagnosis and optimal treatment of SBP. Clinical outcomes associated with EP in patients with community-acquired SBP are not well described.;Aim. To review the medical records of hospitalized patients with cirrhosis and SBP who had early vs. delayed paracentesis (DP) and to assess the impact of EP vs. DP on outcomes.;Methods. Between 1/2005 and 6/2010, consecutive patients who were diagnosed with SBP <72 hours from the first physician encounter at Los Angeles County+USC Medical Center were identified. Clinical features and treatment courses were retrospectively reviewed. EP and DP were defined by undergoing procedure <12 and 12--72 hours from the time of presentation, respectively.;Results. The mean age of 150 patients with SBP was 52.8+/-9.5 years and 63% had alcohol-related liver disease. Sixty-eight (45%), 95 (63%) and 119 (79%) patients underwent paracentesis ≤6, ≤12 and ≤24 hours from presentation. As expected the mean interval to EP was significantly less than the DP group (4.9+/-3.1 vs. 30.6+/-15.3 hours; P<.0001). There were no differences in clinical characteristics on admission between the groups. During hospitalization, 17% of patients died without significant difference between EP and DP (16% vs. 20%; P=0.51) groups. Furthermore, there were no differences in rates of acute kidney injury (30% vs. 33%; P=0.68), ICU length of stay (0.9+/-2.2 vs.1.6+/-4.9; P=0.32), or total length of stay (7.1+/-4.7 vs. 8.9+/-7.5 days; P=0.11) between EP and DP groups;Conclusion. Paracentesis was promptly performed in the majority of patients diagnosed with community-acquired SBP at a large urban medical center. Although there was no significant difference in outcomes between patients who underwent EP and DP, in-hospital mortality was low for all patients with SBP at 17% despite high incidence of renal impairment and high mean MELD score. Further studies with larger number of patients are needed to evaluate the utility of EP in patients with SBP. |
