OCCURRENCE OF SPONTANEOUS BACTERIAL PERITONITIS IN INDIVIDUALS WITH UPPER GASTROINTESTINAL BLEEDING WITHIN THE CONTEXT OF DECOMPENSATED CHRONIC LIVER DISEASE
Main Article Content
Keywords
Spontaneous bacterial peritonitis, Child-Pugh Class, uppe gastrointestinal bleeding, chronic liver disease
Abstract
Objectives: To assess the occurrence of spontaneous bacterial peritonitis in patients with decompensated chronic liver disease who present with upper gastrointestinal bleeding.
Materials and Methods: Following ethical committee approval, this study was conducted in the Gastroenterology Department, DG Khan Medical College DG Khan, Pakistan and Shaikh Zayed Hospital, Lahore in the duration from November 2023 to April 2024. 110 patients meeting selection criteria were enrolled. Each patient underwent clinical exams and lab tests to assess Child-Pugh class and diagnose liver cirrhosis. Patients with decompensated chronic liver disease and upper gastrointestinal bleeding (Child-Pugh Class B and C) were evaluated for spontaneous bacterial peritonitis (SBP), confirmed by specific lab criteria.
Results: The mean age of the 110 patients was 48.04 years (SD 8.46). Of these, 55.5% were male and 44.5% female. Child-Pugh classifications showed 43.6% in Class B and 56.4% in Class C. Spontaneous bacterial peritonitis (SBP) prevalence was 30%. SBP occurrence was stratified by gender and age, with p-values of 0.25 and 0.57, respectively.
Conclusion: Spontaneous bacterial peritonitis is more common in people with upper gastrointestinal bleeding and advanced chronic liver disease, especially those in Child-Pugh Class C compared to Class B.
References
2. Lu Z, Sun X, Han J, Jin B, Zhang W, Han J, et al. Characteristics of peptic ulcer bleeding in cirrhotic patients with esophageal and gastric varices. Scientific Reports. 2020;10(1):20068.
3. Arvaniti V, D'Amico G, Fede G, Manousou P, Tsochatzis E, Pleguezuelo M, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology. 2010;139(4):1246-56. e5.
4. Tandon P, Garcia-Tsao G, editors. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Seminars in liver disease; 2008: © Thieme Medical Publishers.
5. Llovet JM, Bartolí R, March F, Planas R, Viñado B, Cabré E, et al. Translocated intenstinal bacteria cause spontaneous bacterial peritonitis in cirrhotic rats: molecular epidemiologic evidence. Journal of hepatology. 1998;28(2):307-13.
6. Song DS. Spontaneous bacterial peritonitis. The Korean journal of gastroenterology. 2018;72(2):56-63.
7. Rimola A, Soto R, Bory F, Arroyo V, Piera C, Rodes J. Reticuloendothelial system phagocytic activity in cirrhosis and its relation to bacterial infections and prognosis. Hepatology. 1984;4(1):53-8.
8 .Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology. 1984;4(3):447-50.
9. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. New England Journal of Medicine. 1999;341(6):403-9.
10. Ali L, Naeem M, Ullah MI, Aslam M, Ullah H, Masood A, et al. Prevalence of Spontaneous Bacterial Peritonitis in Patients Presenting with Upper Gastrointestinal Bleeding in Decompensated Chronic Liver Disease Patients. Pakistan Journal of Medical & Health Sciences. 2022;16(12):418-.
11. Gunjača I, Francetić I. Prevalence and clinical outcome of spontaneous bacterial peritonitis in hospitalized patients with liver cirrhosis: a prospective observational study in central part of Croatia. Acta Clinica Croatica. 2010;49(1):11-8.
12. Fernández J, Bauer TM, Navasa M, Rodés J. Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. Best Practice & Research Clinical Gastroenterology. 2000;14(6):975-90.
13. Kokab B, Nadeem S, Rehman SU. Spontaneous bacterial peritonitis in cases with liver cirrhosis. Annals of Punjab Medical College (APMC). 2018;12(1):74-6.
14. Nouman S, Hussain A, Hussain M, Ahmed M. Frequency of spontaneous bacterial peritonitis in chronic liver disease. Annals of King Edward Medical University. 2010;16(2):112-.
15. Sherlock S, Dooley J, Iber F. Diseases of the liver and biliary system: Wiley Online Library; 2002.
16. Patel SS, Guzman LA, Lin FP, Pence T, Reichman T, John B, et al. Utilization of aspirin and statin in management of coronary artery disease in patients with cirrhosis undergoing liver transplant evaluation. Liver Transplantation. 2018;24(7):872-80.
17. Garcia-Tsao G, Bosch J. Varices and variceal hemorrhage in cirrhosis: a new view of an old problem. Clinical Gastroenterology and Hepatology. 2015;13(12):2109-17.