SPONTANEOUS BACTERIAL PERITONITIS - OUTCOME AND PREDICTIVE FACTORS

Objective: To identify patients who were most at risk of developing spontaneous bacterial peritonitis and who might benefit from selective intestinal decontamination. Design: Prospective analysis of all patients admitted with liver cirrhosis during a 4-year period who had ascitic fluid analysis and appropriate bed-side inoculation of ascites in blood culture bottles. Setting: Liver transplantation centre in a university hospital. Patients: Thirty-one positive episodes and 92 negative episodes of spontaneous bacterial peritonitis were analysed and compared in 83 patients. Results: The 1-year survival rate after spontaneous bacterial peritonitis was 14% compared with 43% in the group without spontaneous bacterial peritonitis. The calculated recurrence rate was 20%. The Child-Pugh classification and coagulation parameters were identified as predictive factors for the development of spontaneous bacterial peritonitis as was a deterioration in values for liver function tests. The total ascitic fluid protein content was not predictive. Sclerotherapy for oesophageal varices may also be a predictive factor, but this requires further investigation. Conclusions: On the basis of our results, we recommend the use of selective intestinal decontamination for patients with liver cirrhosis Child-Pugh class C and ascites who develop rapidly progressive deterioration of liver function tests, patients who survived a first episode of spontaneous bacterial peritonitis and those awaiting liver transplantation.