Llovet J M, Planas R, Morillas R, Quer J C, Cabré E, Boix J, Humbert P, Guilera M, Doménech E, Bertrán X
Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain.
Am J Gastroenterol. 1993 Mar;88(3):388-92.
In order to identify the predictive factors of hospital mortality in cirrhotics with spontaneous bacterial peritonitis (SBP), we studied 64 patients who fulfilled the accepted diagnostic criteria. All cases were treated with cefotaxime up to 2 days after the infection was considered cured (7.7 +/- 2.9 days). Eleven patients (17%) died while in hospital, six of them before SBP was cured. After uni- and multivariate analyses, only seven routine clinical, biological, and bacteriological variables studied were independently associated with hospital mortality. These were: the presence of upper gastrointestinal bleeding at admission (beta = 2.01), the absence of abdominal pain as presenting symptom (beta = -1.29), the polymorphonuclear count (%) in the ascites (beta = 0.48), prothrombin rate (beta = -0.22), and serum Na (beta = -0.64), creatinine (beta = 0.50), and cholesterol (beta = -0.68). When the equation obtained was computed in a randomly selected sample of the patients studied, it correctly predicted the outcome in 92.3% of the cases. We conclude that short-term outcome of SBP patients depends on the existence of recent gastrointestinal bleeding, the severity of SBP, and the degree of liver and renal failure. The prognostic value of this model needs prospective validation in a new series of patients.
为了确定自发性细菌性腹膜炎（SBP）肝硬化患者医院死亡率的预测因素，我们研究了64例符合公认诊断标准的患者。所有病例均接受头孢噻肟治疗，直至感染被认为治愈后2天（7.7±2.9天）。11例患者（17%）在住院期间死亡，其中6例在SBP治愈前死亡。经过单因素和多因素分析，所研究的7项常规临床、生物学和细菌学变量独立与医院死亡率相关。这些变量为：入院时存在上消化道出血（β=2.01）、无腹痛作为首发症状（β=-1.29）、腹水中多形核细胞计数（%）（β=0.48）、凝血酶原比率（β=-0.22），以及血清钠（β=-0.64）、肌酐（β=0.50）和胆固醇（β=-0.68）。在所研究患者的随机样本中计算所得方程时，它在92.3%的病例中正确预测了结果。我们得出结论，SBP患者的短期预后取决于近期胃肠道出血的存在、SBP的严重程度以及肝肾功能衰竭的程度。该模型的预后价值需要在新的一系列患者中进行前瞻性验证。
