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News

Model to to predict mortality in cirrhosis and spontaneous bacterial peritonitis

September's issue of the American Journal of Gastroenterology validated a model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis.

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Clinicians do not have a validated tool for estimating the short-term mortality associated with spontaneous bacterial peritonitis (SBP).

Accurate prognosis assessment is important for risk stratification and for individualizing therapy.

Dr Puneeta Tandon and colleagues from Korea developed and validated a model for the prediction of 30-day mortality in SBP patients receiving standard medical treatment.

The research team retrospectively identified SBP patients treated at a tertiary care center between 2003 and 2011.

Patients with both variables had 30-day mortality rates of 52%
American Journal of Gastroenterology

Multivariate regression modeling and receiver operating characteristic (ROC) curves were utilized for statistical analysis.

An external data set of 109 SBP patients was utilized for validation.

Of the 184 patients in the training set, 66% were men with a median age of 55 years, a median MELD (Model for End-Stage Liver Disease) score of 20, and a 30-day mortality of 27%.

The researchers found that peripheral blood leukocyte count of 11×109 cells/l or more, and MELD score of 22 or more were independent predictors of 30-day mortality.

The team found that patients with neither, one, or both variables had 30-day mortality rates of 8%, 32%, and 52%, respectively.

The findings in the validation set mirrored the training set.

Dr Tandon's team concludes, "In cirrhotic patients with SBP receiving standard therapy, MELD score of 22 or more and peripheral blood leukocyte count of 11×109 cells/l or more are validated independent predictors of mortality."

"The mortality in a patient without either poor prognostic variable is 10% or less, and with both variables is 50% or more."

"Trials aiming to reduce mortality should target patients in the moderate-risk to high-risk groups."

Am J Gastroenterol 2013; 108: 1473–1479
04 October 2013

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