Terg Rubén, Gadano Adrian, Cartier Mariano, Casciato Paola, Lucero Romina, Muñoz Alberto, Romero Gustavo, Levi Diana, Terg Gonzalo, Miguez Carlos, Abecasis Raquel
Hospital de Gastroenterología Dr. Bonorino Udaondo, Universidad del Salvador, Buenos Aires, Argentina.
Liver Int. 2009 Mar;29(3):415-9. doi: 10.1111/j.1478-3231.2008.01877.x. Epub 2008 Sep 18.
Patients with spontaneous bacterial peritonitis (SBP) are at a high risk for renal failure and death despite successful treatment of infection. Intravenous (IV) albumin administration combined with antibiotic treatment has been shown to significantly decrease these risks. Clinical evidence is lacking on which patients are appropriate candidates for albumin treatment.
To retrospectively analyse the usefulness of serum creatinine and bilirubin levels in predicting renal failure and mortality of patients hospitalized for SBP.
Between March 1995 and September 1998, 127 cirrhotic patients with SBP who had not received plasma expansion were evaluated. Eighty-one patients (64%) were classified as having a high risk for renal failure and mortality (serum bilirubin >4 mg/dl or serum creatinine >1 mg/dl) and 46 (36%) as having a low risk.
At admission, 36.3% of all patients presented renal failure. Mortality during their hospitalization was 23% among those with a high risk and 6.5% among those with a low risk (P=0.01). Renal failure occurred in 23% of the high-risk patients, compared with 2.6% of the low-risk patients (P=0.006). The presence of hyponatraemia was significantly associated with higher mortality and renal failure in the high-risk group.
Our retrospective review of patients with SBP suggests that serum bilirubin levels >4 mg and serum creatinine levels >1 mg/dl at the time of diagnosis represent significant risk factors for the clinical outcomes of patients with SBP. Patients without these risk factors may have a very low likelihood of death or renal failure.
自发性细菌性腹膜炎（SBP）患者即使感染得到成功治疗，仍有发生肾衰竭和死亡的高风险。静脉输注白蛋白联合抗生素治疗已被证明可显著降低这些风险。目前缺乏关于哪些患者适合接受白蛋白治疗的临床证据。
回顾性分析血清肌酐和胆红素水平对因SBP住院患者肾衰竭和死亡率的预测价值。
对1995年3月至1998年9月期间127例未接受扩容治疗的肝硬化SBP患者进行评估。81例患者（64%）被归类为肾衰竭和死亡高风险患者（血清胆红素>4mg/dl或血清肌酐>1mg/dl），46例（36%）为低风险患者。
入院时，所有患者中有36.3%出现肾衰竭。高风险患者住院期间死亡率为23%，低风险患者为6.5%（P=0.01）。高风险患者中23%发生肾衰竭，低风险患者为2.6%（P=0.006）。低钠血症的存在与高风险组较高的死亡率和肾衰竭显著相关。
我们对SBP患者的回顾性研究表明，诊断时血清胆红素水平>4mg和血清肌酐水平>1mg/dl是SBP患者临床结局的重要危险因素。无这些危险因素的患者死亡或发生肾衰竭的可能性可能非常低。
