Melcarne Luigi, Sopeña Julia, Martínez-Cerezo Francisco José, Vergara Mercedes, Miquel Mireia, Sánchez-Delgado Jordi, Dalmau Blai, Machlab Salvador, Portilla Dustin, González-Padrón Yonaisy, Real Álvarez Mónica, Carpintero Chantal, Casas Meritxell
Unidad de Hepatología. Servicio Aparato Digestivo, Hospital Universitari Parc Taulí - Sabadell.
Servicio Aparato Digestivo, Hospital Universitari Joan XXIII - Tarragona.
Rev Esp Enferm Dig. 2018 Feb;110(2):94-101. doi: 10.17235/reed.2017.4517/2016.
Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis.
To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors.
This was a retrospective, multicenter study of patients admitted to hospital for spontaneous bacterial peritonitis between 2008 and 2013. Independent variables related to mortality were analyzed by logistic regression. The prognostic power of the Child Pugh Score, the Model for End-Stage Liver Disease (MELD) and the Charlson index was analyzed by ROC curve.
A total of 159 patients were enrolled, 72% were males with a mean age of 63.5 years and a mean MELD score of 19 (SD ± 9.5). Mortality at 30 and 90 days and one and two years was 21%, 31%, 55% and 69%, respectively. Hepatic encephalopathy (p = 0.008, OR 3.5, 95% CI 1.4-8.8) and kidney function (p = 0.026, OR 2.7, 95% CI 1.13-16.7) were independent factors for short- and long-term mortality. MELD was a good marker of short- and long-term survival (area under the curve [AUC] 0.7: 95% CI 1.02-1.4). The Charlson index was related to long-term mortality (AUC 0.68: 95% CI 0.6-0.77).
Short- and long-term mortality of spontaneous bacterial peritonitis is still high. The main prognostic factors for mortality are impairment of liver and kidney function. MELD and the Charlson index are good markers of survival.
自发性细菌性腹膜炎是一种感染性并发症，对肝硬化患者的生存有负面影响。
分析首次发生细菌性腹膜炎后的短期和长期生存率及相关预后因素。
这是一项对2008年至2013年间因自发性细菌性腹膜炎入院患者的回顾性多中心研究。通过逻辑回归分析与死亡率相关的自变量。通过ROC曲线分析Child Pugh评分、终末期肝病模型（MELD）和Charlson指数的预后能力。
共纳入159例患者，72%为男性，平均年龄63.5岁，平均MELD评分为19（标准差±9.5）。30天、90天、1年和2年的死亡率分别为21%、31%、55%和69%。肝性脑病（p = 0.008，比值比3.5，95%置信区间1.4 - 8.8）和肾功能（p = 0.026，比值比2.7，95%置信区间1.13 - 16.7）是短期和长期死亡率的独立因素。MELD是短期和长期生存的良好指标（曲线下面积[AUC] 0.7：95%置信区间1.02 - 1.4）。Charlson指数与长期死亡率相关（AUC 0.68：95%置信区间0.6 - 0.77）。
自发性细菌性腹膜炎的短期和长期死亡率仍然很高。死亡率的主要预后因素是肝肾功能损害。MELD和Charlson指数是生存的良好指标。
