Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis. A Retrospective Study

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 20-40% in patients with cirrhosis and ascites. Not in all cases it is accompanied by obvious symptoms, which makes early diagnosis difficult. Aim: The aims of this study were to determine several clinical and laboratory features and risk factors in bacterial spontan peritonitis. Methodology: In this study, are included 137 patients diagnosed with decompensated cirrhosis, 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 are analyzed 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. Diagnosis of SBP is based on the European Association for the Study of Liver (EASL) guidelines. The degree of liver function damage is evaluated by the Child-Pough score and MELD score, clinical and laboratory indicators, and complications associated with cirrhosis with 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, 132 males (96.4%) and 5 females (3.6%), where 105 patients were with SBP. According to the evaluation of MELD, it was seen to be higher in the group with PBS than those without PBS (p<0.05). From the laboratory data, in this study seen the level of platelets (p<0.015), serum creatinine level (p<0.001), serum bilirubin level (p<0.002), INR (p<0.049), and prothrombin level (p<0.002) were seen 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 the low level of platelets, prolonged levels of INR and prothrombin, increased levels of creatinine, increased levels of bilirubin, and low ascetic protein. While the most frequent associated complications were hepatic encephalopathy, HRS, G\I hemorrhage, and jaundice.