Serper Marina, Tang Helen, Zhang Siqi, McCullough Alexandra, Kaplan David E, Taddei Tamar H, Mahmud Nadim
Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Hepatology. 2025 Jan 29. doi: 10.1097/HEP.0000000000001251.
Spontaneous bacterial peritonitis (SBP) leads to high rates of acute kidney injury (AKI), hepatorenal syndrome, and mortality. Population-based studies on contemporary SBP epidemiology are needed to inform care. In a large, national cohort of patients diagnosed with SBP and confirmed by ascitic fluid criteria, we characterized ascitic fluid characteristics, in-hospital and 12-month mortality, AKI, and recurrent SBP.
We investigated how individual and bundled quality measures for SBP associated with outcomes after multi-level adjustment for health-system, patient clinical factors, and quality measures. Individual and bundled quality metrics were inpatient antibiotics within 48 hours, i.v. albumin, repeat paracentesis within 48 hours, recognition of SBP, and prophylactic antibiotics upon discharge. Among 4330 patients with newly diagnosed SBP, in-hospital mortality was 15.5%, and 12-month mortality was 56.6%. The incidence of stage 1 AKI was 26.6%, 15.7% for stage 2, and 22.8% for stage 3. The cumulative incidence of recurrent SBP was 10.3%. Guideline-recommended albumin was the only individual metric associated with reduced in-hospital mortality (HR: 0.73, 95% CI: 0.59-0.91). Receipt of a higher number of metrics from the SBP bundle was associated with progressively lower 12-month post-discharge mortality: patients who received 3, 4, and 5 SBP bundle components had 20%, 38%, and 56% lower hazard of mortality, respectively, relative to those receiving 2 or fewer (all p <0.001). The SBP bundle was associated with a lower incidence of stage 3 versus stage 0-2 AKI (OR: 0.66, 95% CI: 0.51-0.86).
Prospective implementation of evidence-based SBP bundles may improve care outcomes and mortality in SBP.
自发性细菌性腹膜炎（SBP）会导致急性肾损伤（AKI）、肝肾综合征及死亡率升高。需要开展基于人群的当代SBP流行病学研究，为临床治疗提供依据。在一个大型全国队列中，纳入经腹水标准确诊为SBP的患者，我们对腹水特征、住院期间及12个月死亡率、AKI及复发性SBP进行了特征描述。
我们研究了在对卫生系统、患者临床因素及质量指标进行多水平调整后，SBP的个体及综合质量指标与预后的相关性。个体及综合质量指标包括48小时内静脉使用抗生素、静脉输注白蛋白、48小时内重复腹腔穿刺、SBP的识别以及出院时预防性使用抗生素。在4330例新诊断的SBP患者中，住院死亡率为15.5%，12个月死亡率为56.6%。1期AKI的发生率为26.6%，2期为15.7%，3期为22.8%。复发性SBP的累积发生率为10.3%。指南推荐的白蛋白是唯一与降低住院死亡率相关的个体指标（HR：0.73，95%CI：0.59-0.91）。从SBP综合指标中获得更多指标与出院后12个月死亡率逐步降低相关：接受3项、4项和5项SBP综合指标的患者相对于接受2项或更少指标的患者，死亡风险分别降低20%、38%和56%（所有p<0.001）。SBP综合指标与3期AKI相对于0-2期AKI的较低发生率相关（OR：0.66，95%CI：0.51-0.86）。
前瞻性实施基于证据的SBP综合指标可能会改善SBP的治疗效果及死亡率。
