Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study
Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study
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DOI：
10.17235/reed.2017.4517/2016
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发表时间：
2018-01-01
期刊：
影响因子：
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通讯作者：
Casas, Meritxell
中科院分区：
文献类型：
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作者：
Melcarne, Luigi;Sopeña, Julia;Casas, Meritxell
前言：自发性细菌性腹膜炎是一种感染性并发症，对肝硬变患者的生存有负面影响。目的：分析首发细菌性腹膜炎患者的短期和长期存活率及其相关预后因素。患者和方法：这是一项对2008-2013年间因自发性细菌性腹膜炎住院的患者进行的多中心回顾性研究。用Logistic回归分析与死亡率相关的自变量。结果：159例患者中，72%为男性，平均年龄63.5岁，平均MELD评分19分(SD+/-9.5)。术后30天、90天、1年、2年死亡率分别为21%、31%、55%、69%。肝性脑病(P=0.008，OR3.5，95%CI1.4~8.8)和肾功能(P=0.026，OR2.7，95%CI1.13~16.7)是影响近期和长期死亡率的独立因素。MELD是短期和长期生存的良好标志(曲线下面积[AUC]0.7：95%CI 1.02-1.4)。Charlson指数与远期死亡率相关(AUC 0.68：95%CI 0.6~0.77)。结论：自发性细菌性腹膜炎近期和远期死亡率仍较高。肝肾功能损害是影响死亡率的主要预后因素。MELD和Charlson指数是很好的生存标志。
Introduction: Spontaneous bacterial peritonitis is an infectious complication with a negative impact on survival of patients with cirrhosis.Objective: To analyze the short- and long-term survival after a first episode of bacterial peritonitis and the associated prognostic factors.Patients and methods: 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.Results: 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).Conclusions: 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.