Poca M, Alvarado-Tapias E, Concepción M, Pérez-Cameo C, Cañete N, Gich I, Romero C, Casas M, Román E, Castells L, Vargas V, Carrión J A, Guarner C, Soriano G
Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.
Aliment Pharmacol Ther. 2016 Sep;44(6):629-37. doi: 10.1111/apt.13745. Epub 2016 Jul 28.
Hospital mortality in patients with spontaneous bacterial peritonitis (SBP) is high despite albumin treatment, particularly in those with worse liver and/or renal function.
To determine the independent predictive factors of in-hospital mortality and to create and validate a predictive model of mortality in patients with SBP.
We analysed all cirrhotic patients with high-risk SBP (serum urea ≥11 mmol/L and/or serum bilirubin ≥68 μmol/L) between 2001 and 2011. We developed a predictive model of in-hospital mortality and validated this in a different cohort.
We included 118 high-risk SBP episodes treated with antibiotics and albumin. In-hospital mortality was 33/118 (28%). The independent predictive factors of in-hospital mortality at SBP diagnosis were serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure. A predictive model including these four variables showed a discrimination accuracy (AUC) of 0.850, 95% CI 0.777-0.922. A cut-off point of 0.245 showed a sensitivity of 0.85 and specificity of 0.75. The in-hospital mortality was 28/49 (57.1%) in patients with a model value ≥0.245, and 5/69 (7.2%) in patients with a model value <0.245 (P < 0.001). The validation series included 161 patients with an in-hospital mortality of 40/161 (24.8%), 30/77 (39.0%) in patients with a model value ≥0.245, and 10/84 (11.9%) in those with a model value <0.245 (P < 0.001).
We developed and validated a predictive model of mortality that includes serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure in high-risk patients with spontaneous bacterial peritonitis. These findings may help to identify patients who would benefit from additional therapeutic strategies.
尽管使用白蛋白治疗，但自发性细菌性腹膜炎（SBP）患者的医院死亡率仍然很高，尤其是那些肝功能和/或肾功能较差的患者。
确定住院死亡率的独立预测因素，并建立和验证SBP患者死亡率的预测模型。
我们分析了2001年至2011年间所有患有高危SBP（血清尿素≥11 mmol/L和/或血清胆红素≥68 μmol/L）的肝硬化患者。我们建立了住院死亡率的预测模型，并在另一个队列中进行了验证。
我们纳入了118例接受抗生素和白蛋白治疗的高危SBP发作患者。住院死亡率为33/118（28%）。SBP诊断时住院死亡率的独立预测因素为血清尿素、血白细胞计数、Child-Pugh评分和平均动脉压。包含这四个变量的预测模型显示判别准确性（AUC）为0.850，95%CI为0.777 - 0.922。截断点为0.245时，敏感性为0.85，特异性为0.75。模型值≥0.245的患者住院死亡率为28/49（57.1%），模型值<0.245的患者住院死亡率为5/69（7.2%）（P < 0.001）。验证系列包括161例患者，住院死亡率为40/161（24.8%），模型值≥0.245的患者为30/77（39.0%），模型值<0.245的患者为10/84（11.9%）（P < 0.001）。
我们建立并验证了一个死亡率预测模型，该模型包括血清尿素、血白细胞计数、Child-Pugh评分和平均动脉压，用于高危自发性细菌性腹膜炎患者。这些发现可能有助于识别那些将从额外治疗策略中获益的患者。
