How does spontaneous bacterial peritonitis (SBP) occur?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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SBP can occur as a complication of any disease state that produces the clinical syndrome of ascites, such as heart failure and Budd-Chiari syndrome. Children with nephrosis or systemic lupus erythematosus who have ascites have a high risk of developing SBP. The highest risk of SBP, however is in patients with cirrhosis who are in a decompensated state. [5] In particular, decreased hepatic synthetic function with associated low total protein level, low complement levels, or prolonged prothrombin time (PT) is associated with maximum risk. Patients with low protein levels in ascitic fluid (< 1 g/dL) have a 10-fold higher risk of developing SBP than those with a protein level greater than 1 g/dL. Approximately 10-30% of patients with cirrhosis and ascites develop SBP. [6] The incidence rises to more than 40% with ascitic fluid protein contents of less than 1 g/dL (which occurs 15% of patients), presumably because of decreased ascitic fluid opsonic activity.

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