This study was aimed to identify prognostic factors for in hospital mortality in patients with SBP and to evaluate and compare the predictive power of MELD and IMELD scores for in hospital mortality in patients with SBP.
This study was conducted on 50 patients suffering from spontaneous bacterial peritonitis attending The Department of Hepatology, Gastroenterology and Infectious diseases, Benha University Hospital. All patients included in this study were subjected to full history taking, thorough clinical examination ,full laboratory investigations as CBC, liver panel tests, serum creatinine , serum bilirubin ( total and direct) , Prothrombin time and concentration, Serum albumin, viral markers including (HCV Ab and HBs Ag) , Abdominal ultrasonography and Ascitic fluid analysis.
Patients were classified into two groups:
• Group )1(: alive SBP cases .
• Group) 2(: dead SBP cases .
The present study found that:
Age of patients was higher in group (2) than group (1).
Melena, hematemesis and loss of weight were higher in. group (2) than group (1) while constipation more in group (1).
There was a highly significant difference between the studied groups regarding hepatic encephalopathy as 85 % of dead SBP cases had hepatic Encephalopathy VS 10% of alive SBP cases.
Total bilirubin , Direct Bilirubin, urea, Creatinine, ,INR, PT were higher in group (2) than group (1) while Haemoglobin, Na, K, pc were higher in group (1) than group (2).
Ascites was more tense and portal vein thrombosis was more common in group (2) than group (2).
There was a highly significant difference between the 2 group regarding MELD score as the mean of MELD score was 25.67( ± 3.97) in the survivor SBP cases while it was 33.4 (± 3.7) in the dead SBP cases.
There was a highly significant difference between the 2 groups regarding IMELD score as the mean of I MELD score was 54.49(± 7.14 ) in the survivor SBP cases while it was 68.47 (± 6.38) in the dead SBP cases.
The Sensitivity of MELD score was 90% ,the Specificity was 90% ,the PPV was 85.7% ,the NPV was 93,1% , at Cutoff value 30 and AUC (95% CI) was 0.9350 for mortality prediction in SBP cases .
The Sensitivity of I MELD score was 95% ,the Specificity was 86.67% ,the PPV was 82.6 % ,the NPV was 96.3 % at Cutoff value 60.4 and AUC (95% CI) was 0.9400 for mortality prediction in SBP cases .
MELD score and hepatic encephalopathy were the predictors of mortality in the studied SBP cases (OR=1.48; 95% CI 1.02 to 2.14) (OR=9.03; 95% CI 1.29 to 62.93) respectively. .
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