Risk Factors Associated with Mortality for Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis.

BACKGROUND

Spontaneous bacterial peritonitis (SBP) is a leading cause of death from bacterial infection in patients with liver cirrhosis (LC). Mortality associated with SBP is currently greater than 30%.

AIM: To identify risk factors associated with mortality in patients with LC and nosocomial or community-acquired SBP.

METHODS

The study included patients with culture-proven SBP, classified as either nosocomial or community-acquired. Mortality was estimated at 7, 30, 90 and 365 d. Survival was analyzed using Kaplan-Meier curves and log-rank tests as well as Cox proportional hazards models.

RESULTS

Ninety-five patients were included, 58.1% were female, with a mean age of 56.4 years. The overall mortality associated with SBP at 7, 30, 90 and 365 d was 11.8, 25.7, 43.9, and 61.6%, respectively. In adjusted Cox models, nosocomial SBP was associated with a higher mortality risk, with a significant risk reduction of 2.8-4.7% per week (p <0.05) up to week 40. Among patients with community-acquired SBP, a higher risk of death was associated with a higher MELD-Na score and exposure to herbal supplements combined with alcohol abstinence. For patients with nosocomial SBP, high levels of creatinine (≥2.0 mg/dL), a high MELD-Na score, and rifaximin use were associated with a worse prognosis.

CONCLUSIONS

Mortality is high in both types of SBP during the first 365 d, but higher in nosocomial SBP. Time-dependent differences and distinct prognostic factors between the groups highlight the need for individualized risk assessment and management.