Thanks to LFN’s Quick Tips series, you’ve got ascites down pat.
Now it’s time to tackle spontaneous bacterial peritonitis (SBP). Enjoy!
Fernandez J, et al. Hepatology 2002 – changing microbiology of SBP
Fernandez J, et al. Gut 2018 – prevalence of bacterial infections (and SBP) in acute-on-chronic liver failure
Evans LT, et al. Hepatology 2003 – prevalence of asymptomatic SBP in outpatients
Chinnock B, et al. J Emerg Med 2013 – just having a low “clinical impression” for SBP is not good enough! Patients can be asymptomatic!
Runyon BA, et al. Hepatology 1984 – Bruce Runyon’s description of culture-negative neutrocytic ascites.
Gaetano JN, et al. J Gastroenterol Hepatol 2016 – importance of paracentesis on hospitalized patients
Rosenblatt R, et al. Am J Gastroenterol 2019 – differences in outcomes whether paracentesis is performed “early” or “late” on admission
Runyon BA, et al. Gastroenterology 1991 – comparing 5-day vs. 10-day courses of antibiotics in treatment of SBP
Sort P, et al. NEJM 1999 – trial demonstrating the benefit of albumin on reducing HRS, mortality in patients with SBP
Sigal SH, et al. Gut 2007 – small trial suggesting that “low-risk” patients with SBP may not actually need albumin
Mandorfer M, et al. Gastroenterology 2014 – study demonstrating the detrimental effects of B-blockers during treatment of SBP
Dam G, et al. Hepatology 2016 – study demonstrating that PPI use may increase the risk of SBP
Runyon BA, et al. Gastroenterology 1989 – demonstrating that diuresis (compared to paracentesis) increases ascitic fluid opsonins and serum complements, possibly protecting against SBP
Bernard B, et al. Hepatology 1999 – meta-analysis demonstrating the benefit of antibiotic prophylaxis in patients with GI bleeding
Fernandez J, et al. Gastroenterology 2007 – RCT showing the benefit of primary prophylaxis in select patients with low ascitic fluid protein
Runyon BA. Gastroenterology 1986 – Bruce Runyon describes that low ascitic fluid protein (<1.0) predisposes to SBP
Transplant Hepatologist, University of North Carolina