Jepsen Peter, Vilstrup Hendrik, Møller Jens Kjølseth, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Denmark.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2133-6.
BACKGROUND/AIMS: Patients with liver cirrhosis and ascites have a high risk of spontaneous bacterial peritonitis, but the prognostic impact of spontaneous bacterial peritonitis has not been well examined.
Patients with liver cirrhosis and ascites were included at the time of their first paracentesis during hospitalization in the Department of Hepatology, Aarhus University Hospital, Denmark, between September 1992 and September 2000. Cox regression was used to estimate the mortality of patients with spontaneous bacterial peritonitis (ascites leukocyte count > or = 250 per mm3) relative to controls without spontaneous bacterial peritonitis. Furthermore, we used Cox regression to estimate the change in mortality when controls developed spontaneous bacterial peritonitis during follow-up.
Of 286 patients, 76 (27%) had spontaneous bacterial peritonitis at the first paracentesis. The mortality ratio of patients with spontaneous bacterial peritonitis relative to controls was 1.0 (95% confidence interval 0.7-1.5) after adjustment for age, gender, comorbidity, and alcohol abuse. Of the 210 controls, 42 (20%) were found to have spontaneous bacterial peritonitis at a later paracentesis. Their mortality rate more than doubled with the onset of spontaneous bacterial peritonitis.
Spontaneous bacterial peritonitis at the first paracentesis did not affect the prognosis of patients with liver cirrhosis, whereas development of spontaneous bacterial peritonitis during follow-up doubled the mortality risk. This may be due to a longer diagnostic delay in those who developed spontaneous bacterial peritonitis during follow-up.
背景/目的：肝硬化腹水患者发生自发性细菌性腹膜炎的风险较高，但自发性细菌性腹膜炎对预后的影响尚未得到充分研究。
纳入1992年9月至2000年9月期间在丹麦奥胡斯大学医院肝病科住院首次进行腹腔穿刺时的肝硬化腹水患者。采用Cox回归分析评估自发性细菌性腹膜炎患者（腹水白细胞计数≥250/mm³）相对于无自发性细菌性腹膜炎的对照患者的死亡率。此外，我们使用Cox回归分析评估随访期间对照患者发生自发性细菌性腹膜炎时死亡率的变化。
286例患者中，76例（27%）在首次腹腔穿刺时发生自发性细菌性腹膜炎。在调整年龄、性别、合并症和酒精滥用因素后，自发性细菌性腹膜炎患者相对于对照患者的死亡率比值为1.0（95%置信区间0.7 - 1.5）。在210例对照患者中，42例（20%）在随后的腹腔穿刺时被发现发生自发性细菌性腹膜炎。自发性细菌性腹膜炎发作后，他们的死亡率增加了一倍多。
首次腹腔穿刺时发生的自发性细菌性腹膜炎不影响肝硬化患者的预后，而随访期间发生自发性细菌性腹膜炎会使死亡风险加倍。这可能是由于随访期间发生自发性细菌性腹膜炎的患者诊断延迟时间更长。
