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Delayed Paracentesis Is Associated With Increased In-Hospital Mortality in Patients With Spontaneous Bacterial Peritonitis

Kim, John J MD, MS1,2; Tsukamoto, Michelle M DO3; Mathur, Arvind K MD4; Ghomri, Yashar M DO4; Hou, Linda A MD3; Sheibani, Sarah MD3; Runyon, Bruce A MD5

American Journal of Gastroenterology: September 2014 - Volume 109 - Issue 9 - p 1436–1442
doi: 10.1038/ajg.2014.212
ORIGINAL CONTRIBUTIONS
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OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is associated with high mortality. Early paracentesis (EP) is essential for rapid diagnosis and optimal treatment. The aim of the study is to compare the outcomes of patients with SBP who received EP vs. delayed paracentesis (DP).

METHODS: Consecutive patients who were diagnosed with SBP (ascites neutrophil count ≥250 cells/mm3 and clinical evidence of cirrhosis) <72 h from the first physician encounter at two centers were identified. EP was defined by receiving paracentesis <12 h and DP 12–72 h from hospitalization. Primary outcome was in-hospital mortality.

RESULTS: The mean age of 239 patients with SBP was 53±10 years; mean Model for End-Stage Liver Disease (MELD) score was 22±9. In all, 98 (41%) patients who received DP had a higher in-hospital mortality (27% vs. 13%,P=0.007) compared with 141 (59%) who received EP. Furthermore, DP group had longer intensive care days (4.0±9.5 vs. 1.3±4.1,P=0.008), hospital days (13.0±14.7 vs. 8.4±7.4,P=0.005), and higher 3-month mortality (28/76, 37% vs. 21/98, 21%;P=0.03) compared with the EP group. Adjusting for MELD score ≥22 (adjusted odds ratio (AOR)=5.7, 95% confidence interval (CI)=1.8–18.5) and creatinine levels ≥1.5 mg/dl (AOR=3.2, 95% CI=1.4–7.2), DP was associated with increased in-hospital mortality (AOR=2.7, 95% CI=1.3–4.8). Each hour delay in paracentesis was associated with a 3.3% (95% CI=1.3–5.4%) increase in in-hospital mortality after adjusting for MELD score and creatinine levels.

CONCLUSIONS: Hospitalized patients with SBP who received DP had a 2.7-fold increased risk of mortality adjusting for MELD score and renal dysfunction. Diagnostic paracentesis performed <12 h from hospitalization in patients with cirrhosis and ascites may improve short-term survival.

1Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

2Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, California, USA

3Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA

4Department of Medicine, Loma Linda University Medical Center, Loma Linda, California, USA

5David David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA

Correspondence: John J. Kim, Division of Gastroenterology, Loma Linda University Medical Center, 11234 Anderson Street, Room 1556, Loma Linda, California 92354, USA. E-mail: jojkim@llu.edu

Received 26 October 2013; accepted 16 June 2014

Guarantor of the article: Bruce A. Runyon, MD.

Specific author contributions: J. Kim: Study design, data collection, analysis and interpretation of data, drafting the manuscript. M. Tsukamoto, A. Mathur, Y. Ghomri, L. Hou, S. Sheibani: Study design, data collection. B. Runyon: Study design, analysis and interpretation of the data, drafting the manuscript. All the authors approved the final draft of the manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2014. All Rights Reserved.
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