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Lee CH, Kang HJ, Yu SY, Seo SY, Kim SH, Kim SW, Lee SO, Lee ST, Kim IH. Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma. Sci Rep 2023; 13:6067. [PMID: 37055466 PMCID: PMC10101952 DOI: 10.1038/s41598-023-32006-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
This study aimed to investigate the initial treatment response and short-term mortality of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with hepatocellular carcinoma (HCC) compared with those without HCC. A total of 245 patients with liver cirrhosis diagnosed with SBP between January 2004 and December 2020 were included. Of these, 107 (43.7%) were diagnosed with HCC. Overall, the rates of initial treatment failure, 7-day and 30-day mortality were 91 (37.1%), 42 (17.1%), and 89 (36.3%), respectively. While the baseline CTP score, MELD score, culture-positive rate, and rates of antibiotic resistance did not differ between both groups, patients with HCC had a higher rate of initial treatment failure than those without HCC patients (52.3% vs. 25.4%, P < 0.001). Similarly, 30-day mortality was also significantly higher in patients with HCC (53.3% vs. 23.2%, P < 0.001). In the multivariate analysis, HCC, renal impairment, CTP grade C, and antibiotic resistance were independent factors for initial treatment failure. Furthermore, HCC, hepatic encephalopathy, MELD score, and initial treatment failure were independent risk factors for 30-day mortality, with statistically significant poor survival outcomes in patients with HCC (P < 0.001). In conclusion, HCC is an independent risk factor for initial treatment failure and high short-term mortality in patients with cirrhosis with SBP. It has been suggested that more attentive therapeutic strategies are required to improve the prognosis of patients with HCC and SBP.
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Affiliation(s)
- Chang Hun Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Hye Jin Kang
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Song Yi Yu
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Seung Young Seo
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Seong Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Seung Ok Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea
| | - In Hee Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, Geonjiro 20, Dukjin-Gu, Jeonju, Jeonbuk, 54907, South Korea.
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Zhu LC, Wu W, Zou B, Gan DK, Lin X, Zhou W, Xiong ML. Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis. Medicine (Baltimore) 2022; 101:e30164. [PMID: 36221348 PMCID: PMC9542963 DOI: 10.1097/md.0000000000030164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Third-generation cephalosporins (3rd GCs) have recently become controversial as the first-line strategy for empirical spontaneous bacterial peritonitis (SBP) treatment. This study aimed to identify SBP treatment efficacy predictors of 3rd GCs. METHODS In this retrospective cohort study, 279 cirrhosis patients with SBP who received 3rd GC monotherapy for initial empirical treatment from 2013 to 2019 were included. Nonresponse was defined as a decreased ascites polymorphonuclear (PMN) count < 25% from baseline after 48 hours of antibacterial treatment. Multivariate regression analysis was used to identify efficacy predictors of 3rd GCs in treating SBP. Kaplan-Meier analysis was used to evaluate survival data. RESULTS The nonresponder group included 120 patients with no response, and the responder group included 159 patients with responses. The response rate to 3rd GCs was 57.0% among all patients. The common pathogens were Escherichia coli (40.6%), Staphylococcus (15.6%), Klebsiella pneumonia (12.5%), and Streptococcus (12.5%) in 32 ascites culture isolates. Nosocomial SBP (NSBP) (odds ratio [OR]: 2.371, 95% confidence interval [CI]: 1.323-4.249, P = .004), pneumonia (OR: 11.561, 95% CI: 1.876-71.257, P = .008), recurrent SBP (OR: 3.386, 95% CI: 1.804-6.357, P < .001), platelet count (≥113.5 × 109/L) (OR: 3.515, 95% CI: 1.973-6.263, P < .001), and ascites PMN count (≤0.760 × 109/L) (OR: 4.967, 95% CI: 2.553-9.663, P < .001) were independent predictors of nonresponse to 3rd GCs against SBP. Survival plot analysis at 30 days showed worse survival for the nonresponders (P = .003). CONCLUSION NSBP, pneumonia, recurrent SBP, increased platelet count, and lower ascites PMN count were independent predictors of nonresponse to 3rd GC in treating SBP. Nonresponse to initial antibiotic treatment was associated with worse survival.
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Affiliation(s)
- Long-Chuan Zhu
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
- *Correspondence: Long-Chuan Zhu, Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, 330002, China. (e-mail: )
| | - Wei Wu
- Department of Digestion, Children’s Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| | - Bo Zou
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Da-Kai Gan
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Xue Lin
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Information Technology, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Mo-Long Xiong
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
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Mohr R, Lutz P. How to reduce mortality of bacterascites-That is the question. Liver Int 2018; 38:2129-2131. [PMID: 30480379 DOI: 10.1111/liv.13976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/12/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Raphael Mohr
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), University of Bonn, Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,German Center for Infection Research (DZIF), University of Bonn, Bonn, Germany
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O'Brien A, China L, Gant V. The potential danger of empiric antimicrobial therapy for nosocomial SBP. Hepatology 2016; 64:2267-2268. [PMID: 27453062 DOI: 10.1002/hep.28733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/18/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Alastair O'Brien
- Institute of Liver and Digestive Health, University College London, London, United Kingdom
| | - Louise China
- Institute of Liver and Digestive Health, University College London, London, United Kingdom
| | - Vanya Gant
- Institute of Liver and Digestive Health, University College London, London, United Kingdom
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Kloß S, Rösch P, Pfister W, Kiehntopf M, Popp J. Toward culture-free Raman spectroscopic identification of pathogens in ascitic fluid. Anal Chem 2014; 87:937-43. [PMID: 25517827 DOI: 10.1021/ac503373r] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The identification of pathogens in ascitic fluid is standardly performed by ascitic fluid culture, but this standard procedure often needs several days. Additionally, more than half of the ascitic fluid cultures are negative in case of suspected spontaneous bacterial peritonitis (SBP). It is therefore important to identify and characterize the causing pathogens since not all of them are covered by the empirical antimicrobial therapy. The aim of this study is to show that pathogen identification in ascitic fluid is possible by means of Raman microspectroscopy and chemometrical evaluation with the advantage of strongly increased speed. Therefore, a Raman database containing more than 10000 single-cell Raman spectra of 34 bacterial strains out of 13 different species was built up. The performance of the used statistical model was validated with independent bacterial strains, which were grown in ascitic fluid.
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Affiliation(s)
- Sandra Kloß
- Institute of Physical Chemistry and Abbe Center of Photonics, University of Jena , Helmholtzweg 4, D-07743 Jena, Germany
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