TY - JOUR
T1 - Outcomes in Patients with Cirrhosis on Primary Compared to Secondary Prophylaxis for Spontaneous Bacterial Peritonitis
AU - Bajaj, Jasmohan S.
AU - Tandon, Puneeta
AU - O'Leary, Jacqueline G.
AU - Wong, Florence
AU - Biggins, Scott W.
AU - Garcia-Tsao, Guadalupe
AU - Kamath, Patrick S.
AU - Maliakkal, Benedict
AU - Fallon, Michael B.
AU - Lai, Jennifer C.
AU - Thuluvath, Paul J.
AU - Vargas, Hugo E.
AU - Subramanian, Ram M.
AU - Thacker, Leroy R.
AU - Reddy, K. Rajender
N1 - Funding Information:
Financial support: This was partly supported by an investigator-initiated grant by Grifols Pharmaceuticals. The sponsors had no role in the study design, collection, analysis, and interpretation of the data and in the writing of the report. Potential competing interests: None for any author.
Publisher Copyright:
© 2019 by The American College of Gastroenterology.
PY - 2019/4/1
Y1 - 2019/4/1
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.
AB - 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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U2 - 10.14309/ajg.0000000000000044
DO - 10.14309/ajg.0000000000000044
M3 - Article
C2 - 30694868
AN - SCOPUS:85064315912
SN - 0002-9270
VL - 114
SP - 599
EP - 606
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 4
ER -