Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis

Jasmohan S. Bajaj, Puneeta Tandon, Jacqueline G. OʼLeary, Florence Wong, Scott W. Biggins, Guadalupe Garcia-Tsao, Patrick Sequeira Kamath, Benedict Maliakkal, Michael B. Fallon, Jennifer C. Lai, Paul J. Thuluvath, Hugo E Vargas, Ram M. Subramanian, Leroy R. Thacker, K. Rajender Reddy

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis. METHODS: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin. RESULTS: Among the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients. DISCUSSION: In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.

Original languageEnglish (US)
Pages (from-to)599-606
Number of pages8
JournalThe American Journal of Gastroenterology
Volume114
Issue number4
DOIs
StatePublished - Apr 1 2019

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Peritonitis
Fibrosis
Inpatients
End Stage Liver Disease
Mortality
Acute Kidney Injury
Serum Albumin
Intensive Care Units
Systemic Inflammatory Response Syndrome
Antibiotic Prophylaxis
Incidence

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis. / Bajaj, Jasmohan S.; Tandon, Puneeta; OʼLeary, Jacqueline G.; Wong, Florence; Biggins, Scott W.; Garcia-Tsao, Guadalupe; Kamath, Patrick Sequeira; Maliakkal, Benedict; Fallon, Michael B.; Lai, Jennifer C.; Thuluvath, Paul J.; Vargas, Hugo E; Subramanian, Ram M.; Thacker, Leroy R.; Reddy, K. Rajender.

In: The American Journal of Gastroenterology, Vol. 114, No. 4, 01.04.2019, p. 599-606.

Research output: Contribution to journalArticle

Bajaj, JS, Tandon, P, OʼLeary, JG, Wong, F, Biggins, SW, Garcia-Tsao, G, Kamath, PS, Maliakkal, B, Fallon, MB, Lai, JC, Thuluvath, PJ, Vargas, HE, Subramanian, RM, Thacker, LR & Reddy, KR 2019, 'Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis', The American Journal of Gastroenterology, vol. 114, no. 4, pp. 599-606. https://doi.org/10.14309/ajg.0000000000000044
Bajaj, Jasmohan S. ; Tandon, Puneeta ; OʼLeary, Jacqueline G. ; Wong, Florence ; Biggins, Scott W. ; Garcia-Tsao, Guadalupe ; Kamath, Patrick Sequeira ; Maliakkal, Benedict ; Fallon, Michael B. ; Lai, Jennifer C. ; Thuluvath, Paul J. ; Vargas, Hugo E ; Subramanian, Ram M. ; Thacker, Leroy R. ; Reddy, K. Rajender. / Outcomes in Patients With Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis. In: The American Journal of Gastroenterology. 2019 ; Vol. 114, No. 4. pp. 599-606.
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AU - Wong, Florence

AU - Biggins, Scott W.

AU - Garcia-Tsao, Guadalupe

AU - Kamath, Patrick Sequeira

AU - Maliakkal, Benedict

AU - Fallon, Michael B.

AU - Lai, Jennifer C.

AU - Thuluvath, Paul J.

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N2 - OBJECTIVES: Antibiotic prophylaxis is recommended for prevention of the first episode of spontaneous bacterial peritonitis (SBP; primary prophylaxis 1°) and subsequent episodes (secondary prophylaxis 2°). We aimed to compare outcomes in cirrhotic inpatients on 1° vs 2° SBP prophylaxis. METHODS: Data from North American Consortium for the Study of End-Stage Liver Disease were evaluated for cirrhosis details, reasons for admission/medications, inpatient course recorded, and outcomes over 90 days. Outcomes (intensive care units, acute kidney injury, inpatient/90-day mortality) were compared between the 2 groups after propensity-matching on admission model for end-stage liver disease (MELD) score and serum albumin. RESULTS: Among the 2,731 patients enrolled, 305 were on 1° and 187 on 2° SBP prophylaxis. After propensity-matching, 154 patients remained in each group. Patients on 1° prophylaxis were more likely to have admission systemic inflammatory response syndrome (P = 0.02), with higher intensive care unit admissions (31% vs 21%; P = 0.05) and inpatient mortality (19% vs 9%; P = 0.01) than the 2° prophylaxis group. Patients on 2° prophylaxis had higher total (22% vs 10%; P = 0004), readmission (16% vs 9%; P = 0.03), and nosocomial (6% vs 0.5%; P = 0.01) SBP rates with predominant Gram-negative organisms compared to 1° prophylaxis patients. At 90 days, 1° prophylaxis patients had a higher mortality (35% vs 22%; P = 0.02) and acute kidney injury incidence (48% vs 30%; P = 0.04) compared to 2° prophylaxis patients. DISCUSSION: In this inpatient cirrhosis study, despite prophylaxis, a high proportion of patients developed SBP, which was associated with mortality. Cirrhotic inpatients on 1° prophylaxis had worse outcomes than those on 2° prophylaxis when propensity-matched for the MELD score and serum albumin during the index admission and 90-day follow-up.

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