A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis

Background: Recent studies suggest that follow-up paracentesis (FuP) in cases of spontaneous bacterial peritonitis (SBP) should only be performed if there is a clinical and/or analytic worsening. We aimed to evaluate which patients with SBP would benefit from the FuP. Métodos: This retrospective stu...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Ana Luísa Santos, Rosa Coelho, Marco Silva, Rui Morais, Hélder Cardoso, Guilherme Macedo
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	spontaneous bacterial peritonitis liver cirrhosis antibiotics paracentesis Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/de25f3fcf9864473b664d543a86ab325
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:de25f3fcf9864473b664d543a86ab325
record_format	dspace
spelling	oai:doaj.org-article:de25f3fcf9864473b664d543a86ab3252021-12-02T12:40:23ZA Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis2341-45452387-195410.1159/000519934https://doaj.org/article/de25f3fcf9864473b664d543a86ab3252021-11-01T00:00:00Zhttps://www.karger.com/Article/FullText/519934https://doaj.org/toc/2341-4545https://doaj.org/toc/2387-1954Background: Recent studies suggest that follow-up paracentesis (FuP) in cases of spontaneous bacterial peritonitis (SBP) should only be performed if there is a clinical and/or analytic worsening. We aimed to evaluate which patients with SBP would benefit from the FuP. Métodos: This retrospective study included consecutive patients diagnosed with SBP between January 2011 and June 2018 in our tertiary center. Clinical and analytical data were obtained at baseline and on the third day of antibiotic therapy. An adequate response on the third day of treatment was defined by a decrease of ≥25% in the neutrophil count of the ascitic fluid (AF). Results: Ninety-six episodes of PBE in 75 patients (79% male sex, mean age 61 ± 11 years old) were included. At admission, a higher serum neutrophil count (p = 0.043), a lower level of serum total proteins (p = 0.040), a positive culture in AF (p < 0.001) and a previous diagnosis of diabetes mellitus (p = 0.035) were related to inadequate response (IR). At day 3, acute kidney injury (p = 0.023), C-reactive protein >100 mg/L (p < 0.001), the presence of fever (p = 0.047) and abdominal pain (p < 0.001) were also associated with IR. In multivariate analysis, the presence of respiratory insufficiency (OR = 16.403; 95% CI: 2.315–116.222; p = 0.005) and abdominal pain (OR = 10.381; 95% CI: 1.807–59.626; p = 0.009) at admission, serum white blood cell count >9 × 109 (OR = 5.832; 95% CI: 1.275–26.669; p = 0.023), and CRP >100 mg/L (OR = 5.043; 95% CI: 1.267–20.076; p = 0.022) at day 3 of antibiotic therapy were predictors of IR. The predictive model presented good accuracy [AUROC of 0.893 (p < 0.001)] – a cutoff of 0.090 had a sensitivity, specificity, positive predictive value, and negative predictive value for IR of 97, 46, 83, and 77%, respectively. Conclusions: The performance of FuP on day 3 after the beginning of empiric therapy should be individualized, according to clinical and analytic variables of this predictive model.Ana Luísa SantosRosa CoelhoMarco SilvaRui MoraisHélder CardosoGuilherme MacedoKarger Publishersarticlespontaneous bacterial peritonitislivercirrhosisantibioticsparacentesisDiseases of the digestive system. GastroenterologyRC799-869ENGE: Portuguese Journal of Gastroenterology, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	spontaneous bacterial peritonitis liver cirrhosis antibiotics paracentesis Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	spontaneous bacterial peritonitis liver cirrhosis antibiotics paracentesis Diseases of the digestive system. Gastroenterology RC799-869 Ana Luísa Santos Rosa Coelho Marco Silva Rui Morais Hélder Cardoso Guilherme Macedo A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
description	Background: Recent studies suggest that follow-up paracentesis (FuP) in cases of spontaneous bacterial peritonitis (SBP) should only be performed if there is a clinical and/or analytic worsening. We aimed to evaluate which patients with SBP would benefit from the FuP. Métodos: This retrospective study included consecutive patients diagnosed with SBP between January 2011 and June 2018 in our tertiary center. Clinical and analytical data were obtained at baseline and on the third day of antibiotic therapy. An adequate response on the third day of treatment was defined by a decrease of ≥25% in the neutrophil count of the ascitic fluid (AF). Results: Ninety-six episodes of PBE in 75 patients (79% male sex, mean age 61 ± 11 years old) were included. At admission, a higher serum neutrophil count (p = 0.043), a lower level of serum total proteins (p = 0.040), a positive culture in AF (p < 0.001) and a previous diagnosis of diabetes mellitus (p = 0.035) were related to inadequate response (IR). At day 3, acute kidney injury (p = 0.023), C-reactive protein >100 mg/L (p < 0.001), the presence of fever (p = 0.047) and abdominal pain (p < 0.001) were also associated with IR. In multivariate analysis, the presence of respiratory insufficiency (OR = 16.403; 95% CI: 2.315–116.222; p = 0.005) and abdominal pain (OR = 10.381; 95% CI: 1.807–59.626; p = 0.009) at admission, serum white blood cell count >9 × 109 (OR = 5.832; 95% CI: 1.275–26.669; p = 0.023), and CRP >100 mg/L (OR = 5.043; 95% CI: 1.267–20.076; p = 0.022) at day 3 of antibiotic therapy were predictors of IR. The predictive model presented good accuracy [AUROC of 0.893 (p < 0.001)] – a cutoff of 0.090 had a sensitivity, specificity, positive predictive value, and negative predictive value for IR of 97, 46, 83, and 77%, respectively. Conclusions: The performance of FuP on day 3 after the beginning of empiric therapy should be individualized, according to clinical and analytic variables of this predictive model.
format	article
author	Ana Luísa Santos Rosa Coelho Marco Silva Rui Morais Hélder Cardoso Guilherme Macedo
author_facet	Ana Luísa Santos Rosa Coelho Marco Silva Rui Morais Hélder Cardoso Guilherme Macedo
author_sort	Ana Luísa Santos
title	A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
title_short	A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
title_full	A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
title_fullStr	A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
title_full_unstemmed	A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis
title_sort	predictive model for avoiding follow-up paracentesis in spontaneous bacterial peritonitis
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/de25f3fcf9864473b664d543a86ab325
work_keys_str_mv	AT analuisasantos apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT rosacoelho apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT marcosilva apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT ruimorais apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT heldercardoso apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT guilhermemacedo apredictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT analuisasantos predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT rosacoelho predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT marcosilva predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT ruimorais predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT heldercardoso predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis AT guilhermemacedo predictivemodelforavoidingfollowupparacentesisinspontaneousbacterialperitonitis
_version_	1718393771239931904

A Predictive Model for Avoiding Follow-Up Paracentesis in Spontaneous Bacterial Peritonitis

Ejemplares similares