Recurrent and treatment-unresponsive spontaneous bacterial peritonitis worsens survival in decompensated liver cirrhosis

Abstract Background/objectives Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. Methods Two hundred and two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP were included in the study. Results SBP was detected in 28/202 (13.9%) patients; in 26/28 patients the ascitic fluid neutrophils were ≥250/μl, and in 15/28 the cultures were positive. Variables independently associated with SBP were a higher MELD score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall median (range) transplant-free survival was 289 (54-1253) days. One hundred (49.5%) patients died, while 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. Conclusions The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rate.