What are the risk factors for spontaneous bacterial peritonitis (SBP)?

Updated: Nov 26, 2018
  • Author: Thomas E Green, DO, MPH, MMM, CPE, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Patients with cirrhosis who are in a decompensated state are at the highest risk of developing spontaneous bacterial peritonitis. [4] Bacterial translocation (viable microorganism passage from the intestinal lumen to mesenteric lymph nodes) is a key factor in the development of spontaneous bacterial peritonitis. [5] Low complement levels are associated with the development of spontaneous bacterial peritonitis. Patients at greatest risk for spontaneous bacterial peritonitis have decreased hepatic synthetic function with associated low total protein level or prolonged prothrombin time (PT).

Patients with low protein levels in ascitic fluid (< 1 g/dL) have a 10-fold higher risk of developing spontaneous bacterial peritonitis than those with a protein level greater than 1 g/dL.

A 2014 prospective study by Terg et al [6] demonstrated that proton pump inhibitor therapy (specifically evaluated at admission) was not associated with a higher risk of spontaneous bacterial peritonitis. This finding was contrary to findings by previously published studies (2012 review by Siple et al [7] and a 2013 study by Deshpande et al [8] , which had reported several case studies and cohorts of patients with cirrhosis and chronic liver disease who were on proton pump inhibitors (PPIs) for a prolonged duration who were at significantly increased risk for the development of spontaneous bacterial peritonitis. .


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