Factores asociados a peritonitis primaria en pacientes con cirrosis hepática. Revisión sistemática

Abstract

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients, developed by a state of immune deterioration leading to bacterial translocation (BT). Objective: To identify factors related to SBP in cirrhotic patients. Methodology: A systematic search was conducted under PRISMA standards, and 15 articles published since 2018 that met the inclusion criteria were included. Results: The factors are: Child-Pugh-C (OR: 3.323; P=0.009), PMN in LA (OR: 1.544; P=0.028), Na ↓ (OR: 0.917; P=0.029). PPI (OR= 4.24, 95 % CI: 3.83 - 4.7, P<0.0001), Variceal bleeding (OR: 3.28, 95 % CI: 2.85 - 3.80), age ≤65 (OR= 1.62, 95 % CI: 1.47- 1.78, P<0.0001), or 58. 33±7.91 (P═0.87), race; non-Caucasian (OR= 1.23; 95% CI: 1.10 - 1.46, P< 0.0001), male sex (OR= 1.12; 95% CI: 1.02 - 1.23, P< 0.013). Prokinetics (OR =3.2, 95% CI: 1.02-10.04), antibiotics (OR= 2.95, 95% CI: 1.05-5.23). MELD (OR: 1.565; P=0.001), PCR (OR: 1.067; P=0.037). Creatinine ≥2 mg/dL (OR 1.680, 95% CI, p═0.005), sensitivity 77.4%, specificity 74.3%, AUC ROC curve 0.78 for determining in-hospital mortality. Conclusion: SBP is favored by: progressive hepatic dysfunction, especially in Child-Pugh-C, altering the organism regulatory mechanisms, especially in men over 65. The risk increases with antibiotics, prokinetics, and PPIs, altering the intestinal microbiota and increasing antibiotic resistance, favoring BT by modifying PMN values in LA.