P0917 - Demographic Factors Associated With the Severity of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Retrospective Analysis

Prutha Shah, DO¹, Richard Kalman, MD², Nandakumar Mohan, DO¹, Otoniel Ysea Hill, MD¹, Matthew Moran, MD¹, Jessica Genkil, DO¹, Blanche B. Echikunwoke, MD¹, Oluwanifemi Balogun, MD¹, Edward Bley, DO¹, Ahmer Khan, MBBS^1
1Albert Einstein Medical Center, Philadelphia, PA; ²Einstein Medical Center, Philadelphia, PA

Introduction: Spontaneous bacterial peritonitis (SBP) is defined as an infection of the ascitic fluid without an obvious intraabdominal source. Approximately 25% of patients with cirrhosis develop SBP, which has a 20% in-hospital mortality rate. While SBP is a well-studied entity, data demonstrating associations between demographic factors such as age, race, gender, and disease severity is scarce. This study aims to explore the relationship of demographic factors with the severity of SBP at our institution.

Methods: The diagnosis of SBP was established using the diagnostic criteria of PMN cell count of > 250 cells/mm³ in the ascitic fluid. Exclusion criteria included an alternative source of intraabdominal infection, lack of ascitic fluid analysis, history of SBP, age under 18, pregnancy, or history of liver transplant. Acute kidney injury (AKI) was used as the marker for severe SBP. Baseline characteristics were presented as frequency (percent) for categorical variables and as means and interquartile range (IQR) for continuous variables. We calculated odds ratios (OR) and 95% confidence intervals (CI) using a multivariate binomial logistic regression model adjusted for age, gender, race, ethnicity, and county of origin (independent variables) to assess their association with the following dependent variables: all-cause in-hospital mortality and AKI in decompensated cirrhosis with SBP.

Results: Out of 3999 patients with cirrhosis, 4% (n=168) were diagnosed with SBP and thus included. Most patients resided in Philadelphia County (31%, n=52), followed by Montgomery County (26%, n=43). 31.5% (n = 53), 57% (n =96), and 50% (n =84) were found to have HRS, HE, and AKI, respectively. Refer to Table 1. Patients who developed AKI had a higher inpatient mortality risk, OR:3.50 (95%CI:1.32-9.26) than without, p=.012, respectively. African American patients with SBP were found to have higher rates of AKI (64%, n=25) compared to all non-African American patients, p< .044. Patients in Philadelphia County had higher rates of AKI (62%, n=32), compared to suburban counties, p< .045.

Discussion: AKI was proven to be an independent predictor of mortality for our patient cohort and was used as the marker for the severity of disease for patients diagnosed with SBP. We found that African American patients had higher rates of disease severity. Similarly, more patients in Philadelphia County, an urban population, were found to have severe SBP compared to all other counties.



Disclosures:


Prutha Shah, DO¹, Richard Kalman, MD², Nandakumar Mohan, DO¹, Otoniel Ysea Hill, MD¹, Matthew Moran, MD¹, Jessica Genkil, DO¹, Blanche B. Echikunwoke, MD¹, Oluwanifemi Balogun, MD¹, Edward Bley, DO¹, Ahmer Khan, MBBS¹. P0917 - Demographic Factors Associated With the Severity of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Retrospective Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.