Predictive Value Of ALBI Score Combined With PMN And PCT In Spontaneous Bacterial Peritonitis In Patients With Cirrhosis Ascites

Objective:Spontaneous bacterial peritonitis(SBP)is one of the common complications in patients with liver cirrhosis with high incidence and high mortality.Therefore,it is very important to predict the occurrence of SBP.This study included albumin-bilirubin(ALBI)score,polymorphonuclear leucocytes(PMN)count and procalcitonin(PCT),and establish a joint prediction model to explore the predictive efficacy of each index for the occurrence of SBP in patients with cirrhotic ascites,help to guide the clinical screening of high-risk patients with cirrhotic SBP,and carry out early intervention to reduce or avoid its occurrence.Methods:A retrospective study was conducted on patients with cirrhotic ascites who were hospitalized in our Hospital from September 2016 to September 2020.According to the inclusion and exclusion criteria,a total of 215 patients with cirrhotic ascites were included in the study.Among them,55 patients with SBP were assigned to the SBP group,while the other 160 patients without SBP were assigned to the non-SBP group.Collect clinical data of patients,including gender,age,etiology of cirrhosis;laboratory auxiliary examination indicators,including biochemical,coagulation,blood analysis,PCT,CRP,ascites routine and ascites bacterial culture;Complications include hepatic encephalopathy,gastrointestinal bleeding,and so on.ALBI and other scores were calculated according to the above indicators.The t-test,Mann Whitney U test,andχ~2test were used for data analysis and processing.Logistic regression analysis was used to screen risk factors,and a joint prediction model was established.The receiver operating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of each indicator on the occurrence of SBP.Results:1.General data:there were statistical differences in Na~+,urea nitrogen,TBil,creatinine,PT,INR,CRP,PCT,WBC,neutrophils,PMN,hepatic encephalopathy and gastrointestinal bleeding between SBP group and non-SBP group(P<0.05).Related score system:there were statistical differences in ALBI,MELD,MELD-Na and Child-Pugh scores between SBP group and non-SBP group(P<0.05).There was no statistical differences in etiology and ABIC score of liver cirrhosis between the two groups(P>0.05).2.Logistic regression analysis:the results of univariate Logistic regression analysis showed that there were significant differences in ALBI score,Child-Pugh score,MELD score,PCT,PMN,gastrointestinal bleeding and hepatic encephalopathy between the two groups(P<0.05).Further multivariate Logistic regression analysis showed that PCT,PMN and ALBI scores were independent risk factors for SBP in patients with cirrhotic ascites.The joint model is synthesized by the coefficient method,and the calculation formula of the joint model ALBI-PMN-PCT is0.012×PMN+1.241×ALBI+1.795×PCT-2.777.3.The predictive value of ALBI,PCT,PMN and ALBI-PMN-PCT to SBP:the ROC curve was drawn by ALBI score,PMN,PCT and the combined model(ALBI-PMN-PCT).The results showed that the AUC of ALBI,PCT,PMN and ALBI-PMN-PCT were 0.711,0.866,0.875 and0.934 respectively,and the predictive value of AUC was higher than that of single factor.The Yoden index of the joint model is 0.810,the optimal critical value is 0.272,and its sensitivity and specificity are 89.09%and91.87%,respectively.There was statistical differences between ALBI-PMN-PCT model and ROC curve of three single factors(P<0.05).Conclusion:The predictive value of ALBI-PMN-PCT model in predicting the occurrence of SBP in patients with cirrhotic ascites is higher than that of ALBI score,PMN and PCT.When ALBI-PMN-PCT>0.272,it has a strong hint on the occurrence of SBP.