Spontaneous Bacterial Peritonitis and Short-Term Prognosis in a Group of Decompensated Cirrhotic Patients in Yaounde: A Cross-Sectional Study — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Spontaneous Bacterial Peritonitis and Short-Term Prognosis in a Group of Decompensated Cirrhotic Patients in Yaounde: A Cross-Sectional Study
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
,
Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
,
Higher Institute of Medical Technology, Yaounde, Cameroon
,
Yaounde University Teaching Hospital, Yaounde, Cameroon
,
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
,
Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
,
Department of Microbiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
,
Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
1 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
2 Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
3 Higher Institute of Medical Technology, Yaounde, Cameroon
4 Yaounde University Teaching Hospital, Yaounde, Cameroon
5 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
6 Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
7 Department of Microbiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
8 Department of Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
Introduction: Spontaneous bacterial peritonitis (SBP) is among the most common infection s in cirrhotic patients. Data on SBP are rare in Cameroon. This prompted us to carry out this study on patients with decompensated cirrhosis of the liver in Yaounde University Hospital Centre (YUHC). Methods: We carried out a cross-sectional study from December 2015 to June 2016 in three units of YUHC. All patients with decompensated liver cirrhosis were included. Our sampling was consecutive. Diagnosis of cirrhosis was performed, based on clinical, biological and ultrasound criteria. A neutrophil count greater than 250 cell/mm 3 in ascites fluid defined an SBP. Data on socio-demography, clinical presentation, and outcomes were collected. Results: We included 34 decompensated cirrhotic patients (15 males). Patients mean age was 57.5 ± 2 years (SBP positive: 48.7 ± 21.3 versus without SBP: 59.8 ± 19.5, p = 0.22). SBP diagnosis was made in 6 (17.7%) patients. Compared to patients with decompensated liver cirrhosis and without SBP, positive SBP patients had a higher pulse rate (p = 0.002) and respiratory rate (p = 0.02). The patients with SBP were more likely to present these other clinical features: pulse rate >100 (RR: 4.2, [95% CI: 0.7 - 27.7]; p = 0.02), presence of jaundice (RR: 3.4, [95% CI: 0.6 - 21.1]; p = 0.09), being from female gender (RR: 3.2, [95% CI: 0.5 - 19.9]; p = 0.11), advanced liver disease (Child C class) (RR: 2.4, [95% CI: 0.4 - 14.5], p = 0.66), low-plasma albumin (less than 20 g/L) (RR: 1.7, [95% CI: 0.8 - 3.9], p = 0.08), respiratory rate > 30 (RR: 1.6, [95% CI: 0.6 - 3.3], p = 0.05) and fever/hypothermia (RR: 1.5, [95% CI: 0.6 - 3.4]; p = 0.22). Evolution after a 72-hours antibiotherapy was stationary in four cases and unfavorable in two patients, resulting in death. Conclusion: SBP prevalence was 17.7%. SBP patients were younger, from female sex, tachycardia and polypnea, presenting with fever/hypothermia and signs of advanced liver disease than non-SBP patients. Improvement of our technical platform will be useful to determine the cause of cirrhosis and identify the different germs responsible for SBP.
KeywordsSpontaneous Bacterial PeritonitisDecompensated Liver CirrhosisSub-Saharan Africa
Benhamou, J.-P., Erlinger, S., Belghiti, J., Durand, F. and Vilgrain, V. (2000) Maladies du foie et des voies biliaires. Flammarion médecine-sciences, Paris.
Garcia-Tsao, G., Friedman, S., Iredale, J. and Pinzani, M. (2010) Now There Are Many (Stages) Where before There Was One: In Search of a Pathophysiological Classification of Cirrhosis. Hepatology, 51, 1445-1449. https://doi.org/10.1002/hep.23478
Hytiroglou, P., Snover, D.C., Alves, V., Balabaud, C., Bhathal, P.S., Bioulac-Sage, P., et al. (2012) Beyond “Cirrhosis”: A Proposal from the International Liver Pathology Study Group. American Journal of Clinical Pathology, 137, 5-9. https://doi.org/10.1309/AJCP2T2OHTAPBTMP
Aguirre Valadez, J., Torre Delgadillo, A., Chavez Tapia, N. and Zamora Nava, L.E. (2014) Acute-on-Chronic Liver Failure: A Review. Therapeutics and Clinical Risk Management, 10, 295-303. https://doi.org/10.2147/TCRM.S59723
Marcellin, P. and Kutala, B.K. (2018) Liver Diseases: A Major, Neglected Global Public Health Problem Requiring Urgent Actions and Large-Scale Screening. Liver International, 38, 2-6. https://doi.org/10.1111/liv.13682
Blachier, M., Leleu, H., Peck-Radosavljevic, M., Valla, D.-C. and Roudot-Thoraval, F. (2013) The Burden of Liver Disease in Europe: A Review of Available Epidemiological Data. Journal of Hepatology, 58, 593-608. https://doi.org/10.1016/j.jhep.2012.12.005
Setiawan, V.W., Stram, D.O., Porcel, J., Lu, S.C., Le Marchand, L. and Noureddin, M. (2016) Prevalence of Chronic Liver Disease and Cirrhosis by Underlying Cause in Understudied Ethnic Groups: The Multiethnic Cohort. Hepatology, 64, 1969-1977. https://doi.org/10.1002/hep.28677
Mokdad, A.A., Lopez, A.D., Shahraz, S., Lozano, R., Mokdad, A.H., Stanaway, J., et al. (2014) Liver Cirrhosis Mortality in 187 Countries between 1980 and 2010: A Systematic Analysis. BMC Medicine, 12, Article No. 145. https://doi.org/10.1186/s12916-014-0145-y
Vento, S., Dzudzor, B., Cainelli, F. and Tachi, K. (2018) Liver Cirrhosis in Sub-Saharan Africa: Neglected, Yet Important. The Lancet Global Health, 6, e1060-1. https://doi.org/10.1016/S2214-109X(18)30344-9
Conn, H. and Atterbury, C. (1993) Cirrhosis. Schiff’s Liver Diseases. 7th Edition, Lippencott Company, Philadelphia, 875-934.
Strauss, E. and de Sá Ribeiro, M.F.G. (2003) Bacterial Infections Associated with Hepatic Encephalopathy: Prevalence and Outcome. Annals of Hepatology, 2, 41-45. https://doi.org/10.1016/S1665-2681(19)32157-X
D’Amico, G., Garcia-Tsao, G. and Pagliaro, L. (2006) Natural History and Prognostic Indicators of Survival in Cirrhosis: A Systematic Review of 118 Studies. Journal of Hepatology, 44, 217-231. https://doi.org/10.1016/j.jhep.2005.10.013
Rimola, A., García-Tsao, G., Navasa, M., Piddock, L.J., Planas, R., Bernard, B., et al. (2000) Diagnosis, Treatment and Prophylaxis of Spontaneous Bacterial Peritonitis: A Consensus Document. International Ascites Club. Journal of Hepatology, 32, 142-153. https://doi.org/10.1016/S0168-8278(00)80201-9
Bunchorntavakul, C. (2012) Bacterial Infections Other than Spontaneous Bacterial Peritonitis in Cirrhosis. World Journal of Hepatology, 4, 158. https://doi.org/10.4254/wjh.v4.i5.158
Foris, L.A. and Haseeb, M. (2018) Spontaneous Bacterial Peritonitis. StatPearls Publishing, Treasure Island.
Mostafa, E.F. and Mohammad, A.N. (2014) Incidence and Predictors of Rebleeding after Band Ligation of Oesophageal Varices. Arab Journal of Gastroenterology, 15, 135-141. https://doi.org/10.1016/j.ajg.2014.10.002
Bathaix, M.F.Y., Bagny, A., Mahassadi, K.A., Okon, A.J.-B., Kissi-Anzouan, Y.H., Doffou, S., et al. (2015) Prognostic Factors for Cirrhosis Hospital in Abidjan (Côte d’Ivoire). Open Journal of Gastroenterology, 5, 103-109. https://doi.org/10.4236/ojgas.2015.57017
Ennaifer, R., Ouakaa-Kchaou, A., BelHadj, N., Elloumi, H., Gargouri, D., Kochlef, A., et al. (2007) Prognostic Factors for Survival in Cirrhosis. La Tunisie Medicale, 85, 1039-1043.
Ouakaa-Kchaou, A., Belhadj, N., Abdelli, N., Azzouz, M., Ben Mami, N., Dougui, M.H., et al. (2010) Survival in Cirrhosis. La Tunisie Medicale, 88, 804-808.
Ogutu, E.O., Wankya, B.M., Shah, M.V. and Ndinya-Achola, J.O. (1988) Prevalence of Spontaneous Bacterial Peritonitis at Kenyatta National Hospital. East African Medical Journal, 65, 547-551.
Alaniz, C. and Regal, R.E. (2009) Spontaneous Bacterial Peritonitis: A Review of Treatment Options. PT, 34, 204-210.
Evans, L.T., Kim, W.R., Poterucha, J.J. and Kamath, P.S. (2003) Spontaneous Bacterial Peritonitis in Asymptomatic Outpatients with Cirrhotic Ascites. Hepatology, 37, 897-901. https://doi.org/10.1053/jhep.2003.50119
Fernandez, J. and Gustot, T. (2012) Management of Bacterial Infections in Cirrhosis. Journal of Hepatology, 56, S1-S12. https://doi.org/10.1016/S0168-8278(12)60002-6
Dia, D., Serme, Y.K., Bassène, M.L., Halim, A., Diallo, S., Thioubou, M.A., et al. (2014) Spontaneous Bacterial Peritonitis in Dakar, Senegal: Study of 55 Patients with Cirrhosis. Médecine et Santé Tropicales, 24, 55-57. https://doi.org/10.1684/mst.2013.0260
Duah, A. and Nkrumah, K.N. (2019) Prevalence and Predictors for Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites Admitted at Medical Block in Korle-Bu Teaching Hospital, Ghana. The Pan African Medical Journal, 33, 35. https://doi.org/10.11604/pamj.2019.33.35.18029
Noah Noah, D., Eloumou Bagnaka, S.A.F., Ankouane Firmin, A., Bilounga, J.N. and Luma Namme, H. (2016) Complications and Prognosis of Cirrhotic Patients at the Douala General Hospital in Cameroon. Journal of Applied Medical Sciences, 5, 43-52.
Attia, K.A., N’dri-Yoman, T., Sawadogo, A., Mahassadi, A., Bathaix, M.F.Y., Sermé, K., et al. (2001) L’infection spontanée du liquide d’ascite chez le cirrhotique africain. étude descriptive à propos de 12 cas. Bulletin de la Société de Pathologie Exotique, 94, 319-321.
Syed, V.A., Ansari, J.A., Karki, P., Regmi, M. and Khanal, B. (2007) Spontaneous Bacterial Peritonitis (SBP) in Cirrhotic Ascites: A Prospective Study in a Tertiary Care Hospital, Nepal. Kathmandu University Medical Journal, 5, 48-59.
Badawy, A.A., Zaher, T.I., Sharaf, S.M., Emara, M.H., Shaheen, N.E. and Aly, T.F. (2013) Effect of Alternative Antibiotics in Treatment of Cefotaxime Resistant Spontaneous Bacterial Peritonitis. World Journal of Gastroenterology, 19, 1271-1277. https://doi.org/10.3748/wjg.v19.i8.1271
Oladimeji, A.A., Temi, A.P., Adekunle, A.E., Taiwo, R.H., Ayokunle, D.S. (2013) Prevalence of Spontaneous Bacterial Peritonitis in Liver Cirrhosis with Ascites. The Pan African Medical Journal, 15, 128. https://doi.org/10.11604/pamj.2013.15.128.2702
Obstein, K.L., Campbell, M.S., Reddy, K.R. and Yang, Y.-X. (2007) Association between Model for End-Stage Liver Disease and Spontaneous Bacterial Peritonitis. American Journal of Gastroenterology, 102, 2732-2736. https://doi.org/10.1111/j.1572-0241.2007.01485.x
Gayatri, A.A.A.Y., Suryadharma, I.A., Purwadi, N. and Wibawa, I.D.N. (2007) The Relationship between a Model of End-Stage Liver Disease Score (MELD Score) and the Occurrence of Spontaneous Bacterial Peritonitis in Liver Cirrhotic Patients. Acta Medica Indonesiana, 39, 75-78.
Nousbaum, J.-B., Cadranel, J.-F., Nahon, P., Khac, E.N., Moreau, R., Thévenot, T., et al. (2007) Diagnostic Accuracy of the Multistix 8 SG Reagent Strip in Diagnosis of Spontaneous Bacterial Peritonitis. Hepatology, 45, 1275-1281. https://doi.org/10.1002/hep.21588
Thanopoulou, A.C., Koskinas, J.S. and Hadziyannis, S.J. (2002) Spontaneous Bacterial Peritonitis (SBP): Clinical, Laboratory, and Prognostic Features. A Single-Center Experience. European Journal of Internal Medicine, 13, 194-198. https://doi.org/10.1016/S0953-6205(02)00027-4