Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in patients with liver cirrhosis, which is associated with high mortality. Various studies have shown that the prevalence of SBP varies from 20% to 40% in patients with cirrhosis and ascites. Not in all cases is it accompanied by noticeable symptoms, which makes early diagnosis difficult.

This study aimed to determine several clinical and laboratory features and risk factors in bacterial spontaneous peritonitis.

Methodology: In this study, 137 patients diagnosed with decompensated cirrhosis were divided into three groups: 83 cases with SBP and alcoholic cirrhosis, 22 cases with SBP and viral cirrhosis, and 32 cases with cirrhosis without SBP. All patients included in this study were over 18 years old. This is a retrospective study, where clinical and laboratory characteristics of patients with SPB and liver cirrhosis, admitted to the Service of Gastro-Hepatology, University Hospital Center, Tirana, Albania, during 2018-2022, are analyzed. Diagnosis of SBP is based on the European Association for the Study of Liver (EASL) guidelines. The Child-Pugh score and MELD score evaluate the degree of liver function damage, clinical and laboratory indicators, complications associated with cirrhosis, and PBS and ascitic fluid analyses. All categorical variables were analyzed by using SPSS version 25, and t-tests were used for continuous data.

Results: The average age of the 137 participants in the study was 54.15±12.5 years, with 132 males (96.4%) and 5 females (3.6%), and 105 patients had SBP. According to the MELD evaluation, the group with PBS had a higher value than those without PBS (p<0.05). From the laboratory data, this study identified the levels of platelets (p<0.015), serum creatinine (p<0.001), serum bilirubin (p<0.002), INR (p<0.049), and prothrombin (p<0.002) as predictive factors. The most frequent complications accompanying SBP were Encephalopathy (p<0.004), hepatorenal syndrome (p<0.002), and gastrointestinal hemorrhage (p<0.002).

Conclusions: The most probable predictive factors in the case of PBS in liver decompensated cirrhosis were found to be the low level of platelets, prolonged levels of INR and prothrombin, increased levels of creatinine, increased levels of bilirubin, and low ascetic protein. The most frequent associated complications were hepatic encephalopathy, HRS, GI hemorrhage, and jaundice.

Keywords: SBP, cirrhosis, complications, predictive, alcohol.