EUH Morning Report: Delayed paracentesis and mortality risk with spontaneous bacterial peritonitis

The Bottom Line: In a study of hospitalized patients with spontaneous bacterial peritonitis (SBP), Kim et al (2014) concluded:

  • Patients who receive delayed paracentesis (DP) had a higher in-hospital mortality (27% vs 13%) compared with those who received early paracentesis (EP).
  • Patients who received DP had longer intensive care stays, hospital days, and higher 3-month mortality.
  • DP was associated with a 2.7-fold increase in in-hospital mortality, after adjusting for presenting MELD score and creatinine levels.
  • Each hour delay in the performance of paracentesis from hospitalization was associated with 3.3% increase in in-hospital mortality.
  • Paracentesis performed early on presentation in patients with cirrhosis and ascites may improve short-term survival.

Reference: Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol. 2014 Sep;109(9):1436-42. doi:10.1038/ajg.2014.212.

Summary: Early diagnosis via paracentesis is critical to the successful treatment of patients with SBP. EP is defined as receiving paracentesis < 12h and DP 12-72h from hospitalization.

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(Kim et al, 2014, p.1439)

Patients with cirrhosis frequently develop life-threatening bacterial infections, and SBP is one of the most frequent sources of sepsis in patients with decompensated liver disease. Early detection and initiation of antimicrobial therapy are critical to successful treatment of SBP. Guidelines recommend diagnostic paracentesis in any patient with cirrhosis and ascites admitted to the hospital, presenting with signs and symptoms, or worsening renal and hepatic dysfunction.

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