Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

• Published in: Scientific reports 2021-10, Vol.11 (1), p.21076-21076, Article 21076
• Main Authors: Ruault, Carole, Zappella, Nathalie, Labreuche, Julien, Cronier, Pierrick, Claude, Baptiste, Garnier, Marc, Vieillard-Baron, Antoine, Ortuno, Sofia, Mallet, Maxime, Cosic, Olga, Crosby, Laura, Lesieur, Olivier, Pichon, Nicolas, Galbois, Arnaud, Bruel, Cedric, Ekpe, Kenneth, Sauneuf, Bertrand, Roux, Damien, Legriel, Stephane
• Format: Article
• Language: English
• Subjects: 692/1807/1808; 692/4020/4021/288; Aged; Ascitic fluid; Ascitic Fluid - metabolism; Ascitic Fluid - microbiology; Bacterial Infections - microbiology; Bacterial Infections - mortality; Cirrhosis; Computed tomography; Female; Human health and pathology; Humanities and Social Sciences; Humans; Life Sciences; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - metabolism; Liver Cirrhosis - microbiology; Liver Cirrhosis - mortality; Male; Middle Aged; Mortality; multidisciplinary; Multivariate analysis; Mycoses - microbiology; Mycoses - mortality; Patients; Peritonitis; Peritonitis - etiology; Peritonitis - metabolism; Peritonitis - microbiology; Peritonitis - mortality; Retrospective Studies; Science; Science (multidisciplinary); Surgery
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-00629-4

Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short- and long-term mortality and survivors’ functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm 3 (OR 3.70; 95%CI 1.38–9.85; P  = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30–15.68; P  = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Log-rank test, P  = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.