Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler
Yıl: 2021 Cilt: 20 Sayı: 3 Sayfa Aralığı: 150 - 156 Metin Dili: Türkçe DOI: 10.17941/agd.1055297 İndeks Tarihi: 22-06-2022
Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler
Öz: Giriş ve Amaç: Spontan bakteriyel peritonit, dekompanse karaciğer
sirozunun sık görülen ve mortalitesi yüksek bir komplikasyonudur. Bu
çalışmada spontan bakteriyel peritonitli sirotik hastalarda hastane içi
mortaliteyi etkileyen faktörlerin saptanması amaçlandı. Gereç ve Yöntem: Hastanemiz Gastroenteroloji Kliniği’nde 5 yıllık periyot içinde hastanede yatan 129 sirotik hasta ve bu hastalarda gelişen 151 spontan
bakteriyel peritonit epizodu retrospektif olarak değerlendirildi. Tüm
hastaların demografik özellikleri, laboratuvar parametreleri, asit mayi
tetkikleri, Child-Turcotte-Pugh, son dönem karaciğer hastalığı modeli,
sodyum-son dönem karaciğer hastalığı modeli skorları, siroz komplikasyonları incelendi ve sağ kalan grup ile exitus olan grup bu parametreler
yönünden karşılaştırıldı. Bulgular: Hastaların %57.3’ü (n = 74) erkek ve
%42.7’si (n = 55) kadındı, yaş ortalaması 60.4 ± 12.7 yıl (20 - 90) olarak
bulundu. Hastalarda en sık siroz nedeni %32.6 oranı ile hepatit B virüsü idi. Hastaların %41.7’si Child-Turcotte-Pugh B ve %58.3’ü Child-Turcotte-Pugh-C evresinde idi. Child-Turcotte-Pugh C evresinde hastane
içi mortalite oranı Child-Turcotte-Pugh B evresinde göre anlamlı olarak
yüksekti (p = 0.01). Exitus olan grupta lökosit ve nötrofil sayısı, kan üre
azotu, bilirübin, uluslararası normalleştirilmiş oran değeri ve asit mayi
lökosit ve nötrofil sayısı sağ kalan gruba göre daha yüksek saptandı (p
< 0.001). Child-Turcotte-Pugh, son dönem karaciğer hastalığı modeli
ve sodyum-son dönem karaciğer hastalığı modeli skorunun hastane içi
mortalite ile ilişkili olduğu ve son dönem karaciğer hastalığı modeli skorunun hastane içi mortaliteyi öngörmede sodyum-son dönem karaciğer
hastalığı modeli ve Child-Turcotte-Pugh skorundan daha üstün olduğu
bulundu (p < 0.001). Böbrek yetmezliği gelişen hastalarda hastane
içi mortalite oranı daha yüksekti (%52.7’ye karşı %12.5; p < 0.001).
Hepatik ensefalopati (%48.9’a karşı %17.3; p < 0.001), hepatorenal
sendrom (%85.7’ye karşı %13.8; p < 0.001) ve diğer enfeksiyonların gelişimi (%48.5’e karşı %21.2; p = 0.003) ile hastane içi mortalite arasında
anlamlı ilişki saptandı. Sonuç: Spontan bakteriyel peritonitli hastalarda
lökosit ve nötrofıl yüksekliği, kan üre azotu, bilirübin, uluslararası normalleştirilmiş oran, asit mayi lökosit ve asit mayi nötrofil sayısı yüksekliği
hastane içi mortaliteyi olumsuz yönde etkilemektedir. Hastalarda böbrek yetmezliği gelişimi, asit mayi kültür pozitifliği, hepatik ensefalopati,
hepatorenal sendrom ve enfeksiyon gelişimi hastane içi mortaliteyi arttırmaktadır. Skorlama sistemlerinden son dönem karaciğer hastalığı modeli skoru, hastane içi mortaliteyi öngörmede sodyum-son dönem karaciğer hastalığı modeli ve Child-Turcotte-Pugh skorundan daha üstündür
Anahtar Kelime: Factors affecting in-hospital mortality in patients with spontaneous bacterial peritonitis
Öz: Background and Aims: Spontaneous bacterial peritonitis is a common complication of decompensated liver cirrhosis with a high mortality rate. The aim of this study was to determine the factors affecting
in-hospital mortality in cirrhotic patients with spontaneous bacterial
peritonitis. Materilas and Method: 129 patients with cirrhosis who
were hospitalized in the Gastroenterology Clinic of our Hospital within a 5-year period and 151 episodes of spontaneous bacterial peritonitis developed in these patients were evaluated retrospectively. Demographic characteristics, laboratory parameters, ascitic fluid tests,
Child-Turcotte-Pugh, Model for End-stage Liver Disease, sodium-Model
for End-stage Liver Disease scores, complications of cirrhosis were examined in all patients, and the surviving group and the exitus group
were compared in terms of these parameters. Results: Of the patients,
57.3% (n = 74) were male and 42.7% (n = 55) were female. The mean
age of the patients was 60.4 ± 12.7 (20-90). Hepatitis B virus was the
most common cause of cirrhosis with a rate of 32.6%. Cirrhosis stage
was Child C and Child B in 58.3% and in 41.7% of the patients respectively. In-hospital mortality rate was significantly higher in patients with
Child B cirrhosis stage than those with Child C (p = 0.01). The leukocyte
and neutrophil counts, blood urea nitrogen, bilirubin, international normalised ratio values and ascites leukocyte and neutrophil counts were
found to be higher in the exitus group than the surviving group (p
< 0.001). It was found that Child-Turcotte-Pugh, Model for End-stage
Liver Disease and sodium-Model for End-stage Liver Disease scores were
associated with in-hospital mortality, and Model for End-stage Liver Disease score was superior to sodium-Model for End-stage Liver Disease
and Child-Turcotte-Pugh scores in predicting in-hospital mortality (p <
0.001). In-hospital mortality rate was higher in patients who developed
renal failure (12.5% versus 52.7%; p < 0.001). There was a significant
relationship between in-hospital mortality and hepatic encephalopathy (48.9% vs. 17.3%; p < 0.001), hepatorenal syndrome (85.7% vs.
13.8%; p < 0.001), and the development of infections other than spontaneous bacterial peritonitis (48% vs. %21,2; p = 0.003). Conclusion:
In patients with spontaneous bacterial peritonitis, elevated leukocytes
and neutrophils, high blood urea nitrogen, bilirubin, international normalised ratio values, and high ascitic leukocytes and ascitic fluid neutrophil counts affect in-hospital mortality negatively. Development of
renal failure, positive culture of ascitic fluid, hepatic encephalopathy,
hepatorenal syndrome and infection other than spontaneous bacterial
peritonitis increase in-hospital mortality. Of the scoring systems, the
Model for End-stage Liver Disease score is superior to the sodium-Model
for End-stage Liver Disease and Child-Turcotte-Pugh score in predicting
in-hospital mortality.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Schwabl P, Bucsics T, Soucek K, et al. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites. Liver Int 2015;35:2121-8.
- 2. Niu B, Kim B, Limketkai BN, et al. Mortality from spontaneous bacterial peritonitis among hospitalized patients in the USA. Dig Dis Sci 2018;63:1327-33.
- 3. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60. Epub 2018 Apr 10. Erratum in: J Hepatol 2018;69:1207.
- 4. Marciano S, Díaz JM, Dirchwolf M, Gadano A. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. Hepat Med 2019;11:13-22.
- 5. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010;53:397-417.
- 6. Oliveira AM, Branco JC, Barosa R, et al. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study. Eur J Gastroenterol Hepatol 2016;28:1216-22.
- 7. Thanopoulou AC, Koskinas JS, Hadziyannis SJ. Spontaneous bacterial peritonitis (SBP): clinical, laboratory, and prognostic Features A singlc-center experience. Eur J IntMed 2002;13:194-8.
- 8. Cho JH, Park KH, Kim SH, et al. Bacteremia is aprognostic factor for poor outcome in spontaneous bacterial peritonitis. Scand J Infect Dis 2007;39:697-702.
- 9. Tüzün Y, Kılınç İ, Akın D, et al. Mortality related factors in patients with spontaneous bacterial peritonitis Dicle Tıp Dergisi 2008;35):10- 5.
- 10. Perdomo Coral G, Alves de Mattos. A Renal impairment after spontaneous bacterial peritonitis: incidence and prognosis. Can J Gastroenterol 2003;17:187-90.
- 11. Song JY, Jung SJ, Park CW, et al. Prognostic signiflcance of infeetion acquisition sites in spontaneous bacterial peritonitis: nosocomial versus community acquired. J Korean Med Sci 2006;21:666-71.
- 12. Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994;20:1495-501.
- 13. Cheong HS, Kang CI, Lee JA, et al. Clinical signiflcance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients vvith liver cirrhosis. Clin Infect Dis 2009;48:1230-6.
- 14. Toledo C, Salmeron JM, Rimola A, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology 1993;17:251- 7.
- 15. Filik L, Unal S. Clinical and laboratory Features of Spontaneous Bacterial Peritonitis. E ast Afr Med J 2004;81:474-9
- 16. Khan R, Abid S, Jafri W, et al. Model for end-stage liver disease (MELD) score as a usefiıl prognostic marker in cin’hotic patients with infection. J Coll Physicians Surg Pak 2009;19):694-8.
- 17. Wong VW, Chim AM, Wong GL, et al. Performance of the new MELD-Na score in predicting 3-month and 1-year mortality in Chinese patients with chronic hepatitis B. Liver Transpl 2007;13:1228-35.
- 18. Wang YW, Huo Tl, Yang YY, et al. Correlation and comparison of the model for end-stage liver disease, portal pressure, and serum sodium for outcome prediction in patients with livercirrhosis. J Clin Gastroenterol 2007;41:706-12.
- 19. Selçuk H, Uruc I, Temel MA, et al. Factors prognostic of survival in patients awaiting liver transplantation for end-stage liver disease. Dig Dis Sci 2007;52:3217-23.
- 20. Jenq CC, Tsai MH, Tian YC, et al. Serum sodium predicts prognosis in critically ili cirrhotic patients. Clin Gastroenterol 2010;44:220-6.
- 21. Kim SU, Chon YE, Ece CK, et al. Spontaneous bacterial peritonitis in patients with hepatitis B virus-related liver cirrhosis: community-acquired versus nosocomial. Yonsei Med J 2012;53:328-36.
- 22. Heo J, Seo YS, Yim HJ, et al. Clinical features and prognosis of spontaneous bacterial peritonitis in Korean patients with liver cirrhosis: a multicenter retrospective study. Gut Liver 2009;3:197- 204.
- 23. Nobre SR, Cabral JE, Gomes JJ, et al. In-hospital mortality in spontaneous bacterial peritonitis: a new predictive model. Eur J Gastroenterol Hepatol 2008;20:1176-81.
- 24. Musskopf MI, Fonseca FP, Gass J, et al. Prognostic factors associated with in-hospital mortality in patients with spontaneous bacterial peritonitis. Ann Hepatol 2012;11:915-20
- 25. Merino Rodriguez B, Nunez Martinez O, Diaz Sânchez A, et al. Prognostic value of a spontaneous bacterial peritoııitis episode in cirrhotic patients in clinical practice. Gastroenterol Hepatol 2008;31:560-5.
- 26. Bal CK, Daman R, Bhatia V. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol 2016;8:566-72.
- 27. Tsung PC, Ryu SH, Cha IH, et al. Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. Clin Mol Hepatol 2013;19:131-9.
- 28. Caraceni P, Riggio O, Angeli P et al; ANSWER Study Investigators. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet 2018;391:2417-29. Erratum in: Lancet 2018;392:386.
- 29. Piano S, Brocca A, Mareso S, Angeli P. Infections complicating cirrhosis. Liver Int 2018;38(Suppl 1):126-33.
- 30. Cirera I, Bauer TM, Navasa M, et al. Bacterial translocation of enteric organisms in patients with cirrhosis. J Hepatol 2001;34:32-7.
- 31. Casafont F, Sánchez E, Martín L, Agüero J, Romero FP. Influence of malnutrition on the prevalence of bacterial translocation and spontaneous bacterial peritonitis in experimental cirrhosis in rats. Hepatology 1997;25:1334-7.
- 32. Tandon P, Kumar D, Seo YS, et al. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Am J Gastroenterol 2013;108:1473-9.
APA | GÖKDEMİR R, Ustaoglu M, Eruzun H, Bektas A (2021). Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. , 150 - 156. 10.17941/agd.1055297 |
Chicago | GÖKDEMİR RAMAZAN,Ustaoglu Muge,Eruzun Hasan,Bektas Ahmet Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. (2021): 150 - 156. 10.17941/agd.1055297 |
MLA | GÖKDEMİR RAMAZAN,Ustaoglu Muge,Eruzun Hasan,Bektas Ahmet Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. , 2021, ss.150 - 156. 10.17941/agd.1055297 |
AMA | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. . 2021; 150 - 156. 10.17941/agd.1055297 |
Vancouver | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. . 2021; 150 - 156. 10.17941/agd.1055297 |
IEEE | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A "Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler." , ss.150 - 156, 2021. 10.17941/agd.1055297 |
ISNAD | GÖKDEMİR, RAMAZAN vd. "Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler". (2021), 150-156. https://doi.org/10.17941/agd.1055297 |
APA | GÖKDEMİR R, Ustaoglu M, Eruzun H, Bektas A (2021). Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. Akademik Gastroenteroloji Dergisi, 20(3), 150 - 156. 10.17941/agd.1055297 |
Chicago | GÖKDEMİR RAMAZAN,Ustaoglu Muge,Eruzun Hasan,Bektas Ahmet Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. Akademik Gastroenteroloji Dergisi 20, no.3 (2021): 150 - 156. 10.17941/agd.1055297 |
MLA | GÖKDEMİR RAMAZAN,Ustaoglu Muge,Eruzun Hasan,Bektas Ahmet Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. Akademik Gastroenteroloji Dergisi, vol.20, no.3, 2021, ss.150 - 156. 10.17941/agd.1055297 |
AMA | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. Akademik Gastroenteroloji Dergisi. 2021; 20(3): 150 - 156. 10.17941/agd.1055297 |
Vancouver | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler. Akademik Gastroenteroloji Dergisi. 2021; 20(3): 150 - 156. 10.17941/agd.1055297 |
IEEE | GÖKDEMİR R,Ustaoglu M,Eruzun H,Bektas A "Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler." Akademik Gastroenteroloji Dergisi, 20, ss.150 - 156, 2021. 10.17941/agd.1055297 |
ISNAD | GÖKDEMİR, RAMAZAN vd. "Spontan bakteriyel peritonitli hastalarda hastane içi mortaliteyi etkileyen faktörler". Akademik Gastroenteroloji Dergisi 20/3 (2021), 150-156. https://doi.org/10.17941/agd.1055297 |