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Acute renal failure predicts mortality in cirrhotic patients with spontaneous bacterial peritonitis

Acute renal failure better determined mortality rates in patients with cirrhosis and spontaneous bacterial peritonitis than renal impairment and end-stage renal disease in a recent study.

In a retrospective study, researchers evaluated data taken from the National Health Insurance Database of Taiwan on 2,592 patients with cirrhosis and spontaneous bacterial peritonitis (SBP) hospitalized from January 2004 to December 2004. Mortality rates at 30 days and 1 year were calculated for these patients and compared against matched individuals in a mortality database.

Renal function impairment (RFI) occurred in 11.5% of patients, including 145 instances of acute renal failure (ARF), 70 of end-stage renal disease (ESRD) and 75 of chronic kidney disease (CKD). The overall mortality rate was 21.3% at 30 days, with a significant difference between the rates for patients with RFI (44.0%) and those without RFI (18.4%) (P<.001). A 30-day mortality HR of 3.00 (95% CI, 2.45-3.66) was established for patients with RFI after adjusting for other prognostic factors. At 1 year, the overall mortality rate was 51.7%, with rates of 69.0% for patients with RFI and 49.5% for those without RFI. A 1-year mortality HR of 2.03 (95% CI, 1.66-2.21) was calculated after adjusting for confounders.

Patients with ARF had mortality rates of 62.8% at 30 days and 77.2% at 1 year. Investigators calculated adjusted HRs of 4.68 (95% CI, 3.72-5.88) at 30 days and 2.78 (95% CI, 2.29-3.38) for these patients, compared with those without RFI. Patients with ESRD had mortality rates of 28.6% at 30 days (adjusted HR=1.37; 95% CI, 3.72-5.88) and 62.9% at 1 year (adjusted HR=1.70; 95% CI, 1.26-2.31).

“We performed a nationwide, population-based analysis of 30-day and 1-year mortality rates in cirrhotic patients with SBP, as well as SBP-related mortality rates in cirrhotic patients with ESRD,” the researchers wrote. “This analysis showed that RFI is a poor prognostic factor for cirrhotic patients with SBP. The effect of ARF is more important for SBP mortality in cirrhotic patients.”