Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis
Renal Dysfunction Is the Most Important Independent Predictor of Mortality in Cirrhotic Patients With Spontaneous Bacterial Peritonitis
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DOI：
10.1016/j.cgh.2010.11.038
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发表时间：
2011-03-01
影响因子：
12.6
通讯作者：
Garcia-Tsao, Guadalupe
中科院分区：
文献类型：
--
作者：
Tandon, Puneeta;Garcia-Tsao, Guadalupe
背景与目的：自发性细菌性腹膜炎是肝硬变患者最常见的感染。为了改善患者护理的分层，我们进行了一项系统的回顾，以确定对合并SBP的肝硬变患者死亡率最可靠的预测因素。方法：我们回顾了成人SBP患者的预后研究(只有英文)，SBP的定义是腹水细胞计数大于或等于250个/mm(3)，腹水培养阳性或不阳性。我们只回顾了那些进行生存和多因素分析并报告在30天内住院或死亡的研究。结果：在2008篇可获得的参考文献中，18篇纳入了这项研究(中位数，每项试验115名患者)。患者的中位年龄为56岁(68%为男性)。最常见的死亡预测因素是肾功能不全、SBP下降、免疫抑制因素和医院获得性SBP。使用12项最优质研究进行的敏感性分析确定，肾功能障碍以及血尿素氮和肌酐水平是最重要的变量。肾功能不全患者的死亡率为67%，而肾功能正常患者的死亡率仅为11%。结论：肾功能障碍是影响肝硬变SBP患者预后的主要因素，其次是MELD评分。需要进一步的研究来确定这些因素在接受白蛋白治疗的高危患者中是否仍具有预后价值。风险分层可用于为高危人群选择额外的治疗，如早期血管收缩治疗。
BACKGROUND & AIMS: Spontaneous bacterial peritonitis (SBP) is the most common infection among patients with cirrhosis. To improve stratification of patient care, we performed a systematic review to identify the most robust predictors of mortality in cirrhotic patients with SBP. METHODS: We reviewed prognostic studies (English language only) of adult patients with SBP, defined as a polymorphonuclear ascitic fluid cell count of 250 cells/mm(3) or more, with or without positive results from culture of ascitic fluid. We reviewed only studies that performed survival and multivariate analyses and reported in-hospital or mortalities within 30 days. RESULTS: Of 2008 available references, 18 were included in the study (median, 115 patients per trial). The median age of patients was 56 years (68% male). The most common predictors of death were renal dysfunction, lack of SBP resolution, immunosuppressive factors, and hospital-acquired SBP. Sensitivity analysis using the 12 best-quality studies identified renal dysfunction and levels of blood urea nitrogen and creatinine as the most important variables. The mortality rate among patients with renal dysfunction was 67%, compared with only 11% of patients who maintained normal renal function. CONCLUSIONS: Renal dysfunction is the main prognostic factor for cirrhotic patients with SBP, followed by the MELD score. Further studies are needed to determine whether these factors identified retain prognostic value in high-risk patients who receive albumin. Risk stratification might be used to select additional treatments, such as early vasoconstrictor therapy, for the highest-risk group.