Clinical Features And Predictive Biomarkers Of Spontaneous Bacterial Peritonitis And Suspected Spontaneous Bacterial Peritonitis

BackgroundChina is a large country with numbers of chronic hepatitis B patients.With the progress of the hepatitis,Hepatitis B recurrence can cause liver inflammation,liver fibrosis and cirrhosis,even liver cancer.Ascites is the most common clinical manifestations in patients with cirrhosis decompensation.Portal hypertension was reported as the main mechanism of ascites.Under some vasoactive substances,the pressure of the intestinal capillary and the return flow of lymph increases,leading to the plasma colloid osmotic pressure and tissue fluid reabsorption decreased.Another reason is the severe liver function.Synthesis ability dysfunction results in albumin hypoproteinemia.Most patients with cirrhosis related ascites are renal dysfunction which leads to sodium retention and drainage.The common reasons of repeated readmission in patients with decompensated cirrhosis were ascites and upper gastrointestinal bleeding.Studies have shown that ascites can seriously affect the quality of life in patients with liver cirrhosis and increasing economic burden of medical treatment.Therefore,for the better management of ascites due to cirrhosis,liver cirrhosis patients should receive abdominocentesis and diuretic treatment timely.Risk factors such as infection of ascites,variceal bleeding,and ascites with low protein should be included as management indicators to guide the use of antibiotics and provide better clinical management for cirrhosis patients.It aims to improve the cirrhosis symptoms,the quality of life and the long-term prognosis of cirrhosis patients.The common infection to liver cirrhosis is spontaneous bacterial peritonitis.Study shows that infection is an acute attack of liver cirrhosis complication.If not been controlled in time,it would be progress the development into acute and chronic liver failure,which characterized by multiple organ failure.Therefore,it is very important for early diagnosis o and treatment of ascites infection.However,current clinical criteria for spontaneous bacterial peritonitis are still limited.Along with the development of technology,to find the related indexes of the peripheral blood,ascites samples by means of genomic or proteomic is particularly critical for predicting markers of spontaneous bacterial peritonitis.Aim1)To evaluate the quality indicators of cirrhosis related ascites and its effort on the survival of patients with short-term prognosis including 28 days and 90 days mortality;2)To compare the effect of abdominal paracentesis time(within 24 hours or within 48 hours)on admission on patients' outcome;3)To compare the clinical characteristics of patients with spontaneous bacterial peritonitis and suspected spontaneous bacterial peritonitis;4)To analyze the risk factors of acute renal injury in patients with cirrhosis related ascites;5)To detect the levels of MPO-DNA,TREM-1 and PR3 in ascites,and to search for the biological markers of spontaneous bacterial peritonitis.To find the relation between TREM-1 PR3 level and short term mortality.MethodThe subjects of this study were collected from January 2012 to June 2013 and by means of the electronic data acquisition system(EDC).Admission criteria:1)patients with decompensated cirrhosis;2)acute decompensation occurred within 30 days since admission(ascites,hepatic encephalopathy,upper gastrointestinal bleeding,clear site infection).Exclusion criteria:1)less than 18 years or older than 80 years);2)had clear intrahepatic or extrahepatic tumor;3)with severe extrahepatic disease;4)non-cirrhosis related ascites,Budd Chiari et al).The ascites was collected,according to the Asia Pacific Institute of liver diseases(APSAL)divided into decompensated cirrhosis group and acute and chronic liver failure group.Using enzyme-linked immune reaction for the detection of neutrophil related protease in ascites,such as TREM-1,MPO-DNA,PR3.And we analyzed its ability to predict spontaneous bacterial peritonitis.SPSS20.0 and Graph Pad Prism 6.02 software were used for data analysis and statistical analysis.The measurement data are expressed as mean and standard deviation(four)or median(range).The independent samples T test and non normal distribution were used to compare the differences of components in the normal distribution data.The classification data were expressed by percentage and chi square test to compare the differences between groups.Diagnostic value of biological markers in the diagnosis of spontaneous bacterial peritonitis was used by ROC curve.The risk factors of acute kidney injury were analyzed by univariate analysis,including age,gender,neutrophil count,creatinine and et.al,factors with P<0.05 were included into multivariate analysis.P<0.05 was statistically significant.Result1)Patient with cirrhosis related ascites received early abdominal puncture with higher severity of disease.Received abdominal puncture within 24 hours group had a higher in-hospital mortality compared with the abdominal puncture group within 24 h.2)The incidence of acute renal injury in patients with spontaneous bacterial peritonitis is high,and the short-term mortality is high.The suspected spontaneous bacterial peritonitis is a subgroup of patients with high incidence of acute kidney injury and high short-term mortality3)The independent risk factors of acute renal injury in patients with cirrhosis related ascites were serum bilirubin level and spontaneous bacterial peritonitis.Spontaneous bacterial peritonitis may exacerbate acute decompensated cirrhosis developing into acute and chronic liver failure.4)The levels of TREM-1,protease 3 and MPO-DNA were not correlated with the severity of the disease.TREM-1 and protease 3 can be used as biomarkers for predicting spontaneous bacterial peritonitis in patients with decompensated cirrhosis.And TREM-1 and protease 3 were correlated with short term mortality.