Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Prognosis of Spontaneous Bacterial Peritonitis in Hepatocellular Carcinoma Patients

  • Kim, Jeong Han (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Choe, Won Hyeok (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Kwon, So Young (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Yoo, Byung-chul (Department of Internal Medicine, Konkuk University School of Medicine)
  • Received : 2018.05.16
  • Accepted : 2018.10.02
  • Published : 2018.12.24
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Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a serious infectious complication in patients with liver cirrhosis. However, information about prognosis of SBP in hepatocellular carcinoma (HCC) patients is limited. We investigated the clinical course of SBP in HCC patients. Methods: This study enrolled patients diagnosed with SBP between 2005 and 2017. Medical records of patients were reviewed and clinical course was compared between the non-HCC and HCC groups. Results: In total, 123 SBP cases including 49 HCC cases were enrolled. Men were predominant (48/74, 64.9% vs. 34/49, 69.4%; P = 0.697); median age was 58 years in both non-HCC and HCC groups (P = 0.887). The most common etiology was alcohol (32/74, 43.2%) in non-HCC group and hepatitis B (30/49, 61.2%) in HCC group (P = 0.009). Antibiotic resistance rate was higher in non-HCC than in HCC group (29.7% vs. 12.2%; P = 0.028); in-hospital mortality did not differ between the groups (25/74, 33.8% vs. 13/49, 26.5%; P = 0.431). Development rate of hepatorenal syndrome did not differ between non-HCC and HCC group (14/74, 18.9% vs. 10/49, 20.4%; P = 1.000), but hepatic encephalopathy was less common in HCC group (26/74, 35.2% vs. 9/49, 18.3%; P = 0.008). The most important predictor of in-hospital mortality in patients with HCC was white blood cell count above $11,570cells/mm^3$ (odds ratio, 6.629; 95% confidence interval, 1.652-26.590; P = 0.008). Conclusion: Prognosis of SBP in HCC patients is relatively less severe. This result may be related with reduced antibiotics resistance and lower development rates of other complications, such as hepatic encephalopathy. Degree of systemic inflammation may be the most important factor for in-hospital mortality.

Keywords

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86. https://doi.org/10.1002/ijc.29210
  2. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet 2018;391(10127):1301-14. https://doi.org/10.1016/S0140-6736(18)30010-2
  3. Song IH, Kim KS. Current status of liver diseases in Korea: hepatocellular carcinoma. Korean J Hepatol 2009;15 Suppl 6:S50-9. https://doi.org/10.3350/kjhep.2009.15.S6.S50
  4. Niu B, Kim B, Limketkai BN, Sun J, Li Z, Woreta T, et al. Mortality from spontaneous bacterial peritonitis among hospitalized patients in the USA. Dig Dis Sci 2018;63(5):1327-33. https://doi.org/10.1007/s10620-018-4990-y
  5. Rimola A, Garcia-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000;32(1):142-53. https://doi.org/10.1016/S0168-8278(00)80201-9
  6. Runyon BA; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013;57(4):1651-3. https://doi.org/10.1002/hep.26359
  7. Such J, Runyon BA. Spontaneous bacterial peritonitis. Clin Infect Dis 1998;27(4):669-74. https://doi.org/10.1086/514940
  8. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010;53(3):397-417. https://doi.org/10.1016/j.jhep.2010.05.004
  9. Navasa M, Follo A, Llovet JM, Clemente G, Vargas V, Rimola A, et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996;111(4):1011-7. https://doi.org/10.1016/S0016-5085(96)70069-0
  10. Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology 1991;100(6):1737-42. https://doi.org/10.1016/0016-5085(91)90677-D
  11. Altman C, Grange JD, Amiot X, Pelletier G, Lacaine F, Bodin F, et al. Survival after a first episode of spontaneous bacterial peritonitis. Prognosis of potential candidates for orthotopic liver transplantation. J Gastroenterol Hepatol 1995;10(1):47-50. https://doi.org/10.1111/j.1440-1746.1995.tb01046.x
  12. Koo JK, Kim JH, Choi YJ, Lee CI, Yang JH, Yoon HY, et al. Predictive value of refit model for end-stage liver disease, refit model for end-stage liver disease-Na, and pre-existing scoring system for 3-month mortality in Korean patients with cirrhosis. J Gastroenterol Hepatol 2013;28(7):1209-16. https://doi.org/10.1111/jgh.12156
  13. Kim BH, Park JW. Epidemiology of liver cancer in South Korea. Clin Mol Hepatol 2018;24(1):1-9. https://doi.org/10.3350/cmh.2017.0112
  14. Toledo C, Salmeron JM, Rimola A, Navasa M, Arroyo V, Llach J, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology 1993;17(2):251-7. https://doi.org/10.1002/hep.1840170215
  15. Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis--in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol 2001;96(4):1232-6. https://doi.org/10.1111/j.1572-0241.2001.03708.x
  16. Singal AK, Salameh H, Kamath PS. Prevalence and in-hospital mortality trends of infections among patients with cirrhosis: a nationwide study of hospitalised patients in the United States. Aliment Pharmacol Ther 2014;40(1):105-12. https://doi.org/10.1111/apt.12797
  17. Park JW, Chen M, Colombo M, Roberts LR, Schwartz M, Chen PJ, et al. Global patterns of hepatocellular carcinoma management from diagnosis to death: the BRIDGE Study. Liver Int 2015;35(9):2155-66. https://doi.org/10.1111/liv.12818
  18. Kim BK, Kim SU, Park JY, Kim DY, Ahn SH, Park MS, et al. Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single centre experience from long-term clinical outcomes of 1717 treatment-naive patients with hepatocellular carcinoma. Liver Int 2012;32(7):1120-7. https://doi.org/10.1111/j.1478-3231.2012.02811.x
  19. Kim BH, Lim YS, Kim EY, Kong HJ, Won YJ, Han S, et al. Temporal improvement in survival of patients with hepatocellular carcinoma in a hepatitis B virus-endemic population. J Gastroenterol Hepatol 2018;33(2):475-83. https://doi.org/10.1111/jgh.13848
  20. Kwak HW, Park JW, Nam BH, Yu A, Woo SM, Kim TH, et al. Clinical outcomes of a cohort series of patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. J Gastroenterol Hepatol 2014;29(4):820-9. https://doi.org/10.1111/jgh.12470
  21. Lee YS, Seo YS, Kim JH, Lee J, Kim HR, Yoo YJ, et al. Can more aggressive treatment improve prognosis in patients with hepatocellular carcinoma? A direct comparison of the Hong Kong Liver Cancer and Barcelona Clinic Liver Cancer algorithms. Gut Liver 2018;12(1):94-101. https://doi.org/10.5009/gnl17040
  22. Lee SS, Jeong SH, Byoun YS, Chung SM, Seong MH, Sohn HR, et al. Clinical features and outcome of cryptogenic hepatocellular carcinoma compared to those of viral and alcoholic hepatocellular carcinoma. BMC Cancer 2013;13:335. https://doi.org/10.1186/1471-2407-13-335
  23. El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology 2014;60(5):1767-75. https://doi.org/10.1002/hep.27222
  24. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol 2013;47 Suppl:S2-6. https://doi.org/10.1097/MCG.0b013e3182872f29
  25. Jang JW. Current status of liver diseases in Korea: liver cirrhosis. Korean J Hepatol 2009;15 Suppl 6:S40-9. https://doi.org/10.3350/kjhep.2009.15.S6.S40
  26. Ariza X, Castellote J, Lora-Tamayo J, Girbau A, Salord S, Rota R, et al. Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol 2012;56(4):825-32. https://doi.org/10.1016/j.jhep.2011.11.010
  27. Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, et al. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014;60(6):1310-24. https://doi.org/10.1016/j.jhep.2014.01.024
  28. Fernandez J, Acevedo J, Castro M, Garcia O, de Lope CR, Roca D, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012;55(5):1551-61. https://doi.org/10.1002/hep.25532
  29. Song HG, Lee HC, Joo YH, Jung S, Park YH, Ryu SH, et al. Clinical and microbiological characteristics of spontaneous bacterial peritonitis (SBP) in a recent five year period. Korean J Hepatol 2002;8(1):61-70.
  30. Tsung PC, Ryu SH, Cha IH, Cho HW, Kim JN, Kim YS, et al. Predictive factors that influence the survival rates in liver cirrhosis patients with spontaneous bacterial peritonitis. Clin Mol Hepatol 2013;19(2):131-9. https://doi.org/10.3350/cmh.2013.19.2.131
  31. Park MK, Lee JH, Byun YH, Lee HI, Gwak GY, Choi MS, et al. Changes in the profiles of causative agents and antibiotic resistance rate for spontaneous bacterial peritonitis: an analysis of cultured microorganisms in recent 12 years. Korean J Hepatol 2007;13(3):370-7. https://doi.org/10.3350/kjhep.2007.13.3.370
  32. Kim JH, Jeon YD, Jung IY, Ahn MY, Ahn HW, Ahn JY, et al. Predictive factors of spontaneous bacterial peritonitis caused by gram-positive bacteria in patients with cirrhosis. Medicine (Baltimore) 2016;95(17):e3489. https://doi.org/10.1097/MD.0000000000003489
  33. Cheong HS, Kang CI, Lee JA, Moon SY, Joung MK, Chung DR, et al. Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis. Clin Infect Dis 2009;48(9):1230-6. https://doi.org/10.1086/597585
  34. Heo J, Seo YS, Yim HJ, Hahn T, Park SH, Ahn SH, et al. Clinical features and prognosis of spontaneous bacterial peritonitis in Korean patients with liver cirrhosis: a multicenter retrospective study. Gut Liver 2009;3(3):197-204. https://doi.org/10.5009/gnl.2009.3.3.197
  35. Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines for liver cirrhosis: ascites and related complications. Clin Mol Hepatol 2018;24(3):230-77. https://doi.org/10.3350/cmh.2018.1005
  36. Karvellas CJ, Abraldes JG, Arabi YM, Kumar A; Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock: a retrospective cohort study. Aliment Pharmacol Ther 2015;41(8):747-57. https://doi.org/10.1111/apt.13135
  37. Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994;20(6):1495-501. https://doi.org/10.1002/hep.1840200619
  38. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341(6):403-9. https://doi.org/10.1056/NEJM199908053410603
  39. Tandon P, Kumar D, Seo YS, Chang HJ, Chaulk J, Carbonneau M, et al. The 22/11 risk prediction model: a validated model for predicting 30-day mortality in patients with cirrhosis and spontaneous bacterial peritonitis. Am J Gastroenterol 2013;108(9):1473-9. https://doi.org/10.1038/ajg.2013.204
  40. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144(7):1426-37, 1437.e1-9. https://doi.org/10.1053/j.gastro.2013.02.042
  41. Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2011;9(3):260-5. https://doi.org/10.1016/j.cgh.2010.11.038
  42. Kim JJ, Tsukamoto MM, Mathur AK, Ghomri YM, Hou LA, Sheibani S, et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol 2014;109(9):1436-42. https://doi.org/10.1038/ajg.2014.212
  43. Tito L, Rimola A, Gines P, Llach J, Arroyo V, Rodes J. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology 1988;8(1):27-31. https://doi.org/10.1002/hep.1840080107
  44. Gines P, Rimola A, Planas R, Vargas V, Marco F, Almela M, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology 1990;12(4 Pt 1):716-24. https://doi.org/10.1002/hep.1840120416
  45. Huang CH, Lin CY, Sheen IS, Chen WT, Lin TN, Ho YP, et al. Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: serum albumin as an easy but reliable predictive factor. Liver Int 2011;31(2):184-91. https://doi.org/10.1111/j.1478-3231.2010.02377.x

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