Objective: To investigate the survival outcomes and risk factors for mortality in cirrhotic patients with probable spontaneous bacterial peritonitis (SBP).
Methods: We retrospectively analyzed the clinical data of 323 cirrhotic patients with ascites admitted from June 2021 to May 2022, including 115 patients with SBP [ascites polymorphonuclear leucocyte (PMN) count ≥250/mm3], 52 patients with bacterascites (PMN count < 250/mm3 with positive microbiological finding in ascites), 67 patients with probable SBP (PMN count < 250/mm3 with negative microbiological finding in ascites but clinical symptoms of SBP) and 89 patients without infection (PMN count < 250/mm3 with negative microbiological finding without clinical symptoms of SBP). The clinical characteristics, laboratory data and 90-day mortality of the patients were compared among the 4 groups. Cox proportional hazard model and propensity score matching (PSM) in a 1∶1 ratio were used to analyze the risk factors for mortality in patients with probable SBP.
Results: The patients with probable SBP had a 90-day mortality rate of 43.28%, similar to those of patients with SBP (46.95%, P=0.121) and bacterascites (48.07%, P=0.805) but significantly higher than that of non-infected patients (11.23%, P < 0.001). In the 46 pairs of patients matched using PSM, the 90-day mortality rates were higher in probable SBP group than in non-infected group both before (43.28% vs 11.23%, P < 0.001) and after PSM (34.78% vs 15.21%, P=0.038). Cox regression analysis indicated that probable SBP was an independent predictor of 90-day mortality in cirrhotic patients with ascites (HR=1.539, 95% CI: 1.048-2.261, P=0.028). A Model for End-Stage Liver Disease (MELD) score > 15 (HR=1.943, 95% CI: 1.118-3.377, P=0.018) and procalcitonin level > 0.48 ng/mL (HR=1.989, 95% CI: 1.111-3.560, P=0.021) at diagnostic paracentesis were both independent risk factors for 90-day mortality in patients with probable SBP.
Conclusion: Cirrhotic patients with probable SBP have poor survival outcomes, and their management should be further optimized based on their MELD score and procalcitonin level.
目的: 探讨肝硬化可疑自发性细菌性腹膜炎(SBP)患者临床特征及预后情况，并分析其预后的影响因素。
方法: 回顾性收集解放军总医院第五医学中心2021年6月~2022年5月收治的323例肝硬化失代偿期合并腹水住院患者的临床资料，根据腹水多形核细胞计数(PMN)、常规腹水细菌培养结果及是否伴可疑SBP表现，将患者分为SBP组(腹水PMN计数≥250个/mm3)(n=115)、细菌性腹水(BA)组(PMN计数 < 250个/mm3且腹水细菌培养阳性，n=52)、可疑SBP组(PMN < 250个/mm3，常规腹水细菌培养结果阴性，伴可疑SBP表现，n=67)及无感染组(PMN < 250个/mm3，常规腹水细菌培养结果阴性，无可疑SBP表现，n=89)。比较各组间的一般特征、临床资料、实验室指标及90 d生存状态的差异，进而通过多因素Cox回归模型分析及1∶1倾向性评分匹配(PSM)控制混杂因素分析可疑SBP对肝硬化腹水患者90 d生存状态的影响，同时分析影响可疑SBP组生存状态的影响因素。
结果: 可疑SBP组90 d病死率与SBP组(43.28% vs 46.95%, Log-rank P=0.121)及BA组(43.28% vs 48.07%, Log-rank P=0.805)差异无统计学意义，显著高于无感染组(43.28% vs 11.23%, Log-rank P < 0.001)；经PSM得到临床特征相似的可疑SBP组与无感染组各46例，可疑SBP组病死率PSM前(43.28% vs 11.23%, Log-rank P < 0.001)、PSM后(34.78% vs 15.21%, Log-rank P=0.038)均显著高于无感染组。Cox多因素回归分析结果显示，可疑SBP为肝硬化腹水患者死亡危险因素之一(HR=1.539, 95% CI=1.048~2.261, P=0.028)。终末期肝病模型评分 > 15(HR=1.943, 95% CI: 1.118~3.377, P=0.018)及降钙素原 > 0.48 ng/mL (HR=1.989, 95% CI: 1.111~3.560, P=0.021)是可疑SBP患者90 d预后的独立影响因素。
结论: 可疑SBP患者预后差，应进一步优化其临床管理路径，重点关注患者终末期肝病模型评分及降钙素原水平。
Keywords: liver cirrhosis; prognosis; propensity score matching; risk factors; spontaneous bacterial peritonitis.