Clinical Features,Pathogen Spectrum And Prognosis Of Patients With End-Stage Liver Disease And Ascites Culture-Positive Spontaneous Peritonitis

Objective:The objective of this study was to provide an objective basis for the early diagnosis,clinical treatment and prognosis of patients with SBP by analyzing the pathogenic characteristics,clinical features and prognostic factors of patients with end-stage liver disease complicated with spontaneous bacterial peritonitis(SBP).Methods:1)A retrospective cohort study was used to collect 437 patients with end-stage liver disease complicated with ascites and positive culture from December 2018 to December 2020 in the Fifth Medical Center of PLA General Hospital,with the starting point of patient admission,the follow-up period was 1 year,and the study endpoint was the end of the follow-up period,death,loss to follow-up or liver transplantation.Patients were divided into non-fatal and deceased groups based on clinical outcomes.2)The general condition,medical history data,laboratory indicators,ascites cytology,Child score,MELD score,etc.of the two groups were compared and analyzed,and the survival curve of patients was depicted by Kaplan-Meier method.COX regression simulation analysis was used to screen the factors affecting the prognosis of patients,and the prognostic index(PI)of patients with end-stage liver disease SBP was constructed,and the area under curve(AUC)of patients with receiver operating characteristic(ROC)was used to evaluate their predictive value.3)According to whether the absolute value of ascites Polymorphonuclear cells(PMN)reached the diagnostic criteria of SBP,the patients were divided into the ascites PMN reached the standard group and the ascites PMN failed to reach the standard group for comparative analysis,and the clinical characteristics of different groups were analyzed.4)Analysis of ascites pathogen composition,drug resistance,clinical antibacterial application,prognosis,etc.of patients with SBP.Results:Among the 437 patients included,322 were in the non-fatal group and 115 were in the fatality group,with the one-year case fatality rate of 26.3%.1)The comparative study found that the age,hospitalization ward,underlying liver disease type(cirrhosis/ACLF),comorbidities(gastrointestinal bleeding,hepatorenal syndrome,hepatic encephalopathy),septic shock,and infection of other sites between the two groups were the relevant risk factors affecting their prognosis(P<0.05).In the deceased group,liver function,kidney function and coagulation function were worse,and the infection indexes such as white blood cells,neutrophil percentage,C-reactive protein,and procalcitonin were more significant(P<0.05).The mortality group had a significantly higher ascites PMN≥0.25×109/L than the non-dead group(P<0.05).2)The results of multivariate Cox analysis showed that hepatic encephalopathy,septic shock,AST,ALT,PCT and other independent risk factors for death.3)According to whether the ascites PMN reached the diagnostic criteria of SBP,the ascites PMN reached the standard group and the ascites PMN failed to reach the standard group were compared and analyzed.There were significant differences between the two groups in the causes of liver diseases,body temperature,Hepatorenal syndrome,community-hospital infection,septic shock,infection at other sites,follow-up time,WBC,NE,INR,D-D,TBI1,DBIL,BUN,CR,Glu,CRP,PCT,PTA,eGFR,Child scores and grading,MELD scores(p<0.05).Mortality in the ascites PMN reached the standard group was significantly higher than that failed to reach the standard group at 28days,90 days and 365 days(p<0.05).Gram-negative bacteria accounted for 58.6%in the ascites PMN reached the standard group and 62.7%in the failed to reach the standard group.The survival curve showed that the survival prognosis of the failed to reach the standard group was better than that of the ascites PMN reached the standard group(p<0.005).4)437 pathogenic bacteria were isolated,and 392 patients were single-species infections,including 167 cases of gram-negative bacilli,accounting for 38.4%,and 217 cases of gram-positive cocci,accounting for 55.4%.ICU has a larger proportion of gram-positive cocci than other wards.The proportion of high-grade antibiotics or even two high-grade antibiotics in empiric anti-infective regimens was increased compared with antimicrobials such as penicillin/cephalosporin three-generation combined enzyme inhibitors and cefatris.Conclusion:1)Hepatic encephalopathy,septic shock,AST,ALT,and PCT are risk factors for death in patients with end-stage liver disease and SBP.2)Gram-negative bacteria were predominant in the ascites PMN reached the standard group and gram-positive bacteria were predominant in the failed to reach the standard group.The survival prognosis of the failed to reach the standard group was better than that of the ascites PMN reached the standard group3)SBP is dominated by a single bacterial infection.The top 5 common bacteria are Escherichia coli,Enterococcus faecalis,Staphylococcus epidermidis,Klebsiella pneumoniae,and Staphylococcus hemolyticus.There are more people infected with gram-positive cocci in ICU than in ordinary wards.