Predictors of Spontaneous Bacterial Peritonitis (SBP) in Liver Cirrhosis: Current Knowledge and Future Frontiers

Spontaneous bacterial peritonitis (SBP), an infection of the ascites fluid in the peritoneum that occurs in the absence of another infectious source, is a serious complication that contributes to the high morbidity and mortality rate in patients with liver cirrhosis. Currently, there is a lack of consensus regarding both prevention and treatment strategies amongst the research community. And there are conflicting findings and opinions regarding the role and use of antibiotic therapy and pharmacological gastric acid suppression and their potential associations with SBP prevalence, disease process and progression.

The aim of this article was to explore the current state of knowledge regarding independent predictors of SBP development in liver cirrhosis patients as well as the potential utilization of trace elements (particularly zinc) and inflammatory biomarkers to stratify SBP risk and vulnerability.

The online databases resourced for articles reviewed in the paper included PubMed, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Institutes of Health (NIH), and Google Scholar. Database searches were conducted in September and October 2017. The keywords used to search for articles reviewed in this paper included “spontaneous bacterial peritonitis”, “SBP”, “liver cirrhosis”, “ascites”, “end-stage liver disease”, “ESLD”, “predictors”, “PPI”, “H2RA”, “antibiotic prophylaxis”, “antibiotic resistance”, “zinc”, “mean platelet volume” and “macrophage inflammatory protein”. Furthermore, the reference lists of relevant studies were reviewed in attempt to seek out additional pertinent studies not found in prior searches.

The results of the review shed light on how much is still unknown regarding this disease process and how there is a need to change certain aspects of SBP clinical management in liver cirrhosis based on the high rates of morbidity and complications. And in performing a literature search, it is clear more prospective, randomized controlled trials are required to better assess the risk versus protective factors for SBP development in liver cirrhosis.

In short, more ongoing, prospective studies and trials are needed to judge the true value of the findings in the studies reviewed in hopes that they can guide appropriate prevention, diagnosis, and management of SBP.

Article by Helen Ngo and Raymund Gantioque, from California State University, Los Angeles, USA.

Full access: http://mrw.so/2Z6TVv

Image by locxuan tran, from Flickr-cc.