Características clínicas e laboratoriais da peritonite bacteriana espontânea no sul do Brasil
Palavras-chave:
Cirrose hepática, Ascite, Peritonite, Líquido ascítico, ParacenteseResumo
CONTEXTO E OBJETIVO: Peritonite bacteriana espontânea (PBE) é uma complicação grave que ocorre em 8-27% dos pacientes hospitalizados com cirrose hepática e ascite, e apresenta altas taxas de mortalidade. O objetivo deste estudo é identificar as características clínicas associadas à PBE. TIPO DE ESTUDO E LOCAL: Estudo transversal, conduzido em uma universidade pública. MÉTODOS: O estudo incluiu, consecutivamente, indivíduos com cirrose hepática e ascite entre setembro 2009 e março 2012. Foram incluídos 45 indivíduos com média de idade de 53,2 ± 12,3 anos, sendo 82,2% homens, 73,8% brancos, com MELD (Modelo para Doença Hepática Terminal) de 19,5 ± 7,2, e 33,3% com PBE. Os indivíduos foram divididos em dois grupos: PBE e controles. RESULTADOS: Quando se compararam os indivíduos com PBE aos controles, observou-se menor média de tempo de atividade da protrombina (TAP; 36,1 ± 16,0% versus 47,1 ± 17,2%; P = 0,044) e menor mediana de gradiente albumina soro-ascite (GASA; 1,2 versus 1,7; P = 0,045). Houve tendência do grupo com PBE de apresentar maior média de MELD, sem significância estatística (22,2 ± 7,6 versus 17,9 ± 6,7; P = 0,067). Foi observada forte correlação positiva entre neutrófilos do líquido ascítico e contagem sérica de leucócitos (r = 0,501; P = 0,001) e correlação negativa de neutrófilos do líquido ascítico com TAP (r = -0,385; P = 0,011). CONCLUSÃO: Poucas características estão associadas à presença de PBE, em especial a disfunção hepática, o GASA e a leucocitose periférica.
Downloads
Referências
Arroyo V, Jiménez W. Complications of cirrhosis. II. Renal and circulatory dysfunction. Lights and shadows in an important clinical problem. J Hepatol. 2000;32(1 Suppl):157-70.
Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341(6):403-9.
Toledo C, Salmerón JM, Rimola A, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology. 1993;17(2):251-7.
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology. 1998;27(1):264-72.
Guarner C, Soriano G. Spontaneous bacterial peritonitis. Semin Liver Dis. 1997;17(3):203-17.
Fernández J, Bauer TM, Navasa M, Rodés J. Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. Baillieres Best Pract Res Clin Gastroenterol. 2000;14(6):975-90.
Guarner C, Runyon BA. Macrophage function in cirrhosis and the risk of bacterial infection. Hepatology. 1995;22(1):367-9.
Angeloni S, Leboffe C, Parente A, et al. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice. World J Gastroenterol. 2008;14(17):2757-62.
Castellote J, López C, Gornals J, et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology. 2003;37(4):893-6.
Runyon BA. Strips and tubes: improving the diagnosis of spontaneous bacterial peritonitis. Hepatology. 2003;37(4):745-7.
Kamani L, Mumtaz K, Ahmed U, Ali AW, Jafri W. Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study. BMC Gastroenterol. 2008;8:59.
Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464-70.
Thanopoulou AC, Koskinas JS, Hadziyannis SJ. Spontaneous bacterial peritonitis (SBP): clinical, laboratory, and prognostic features. A single-center experience. Eur J Intern Med. 2002;13(3):194-8.
Kasztelan-Szczerbinska B, Slomka M, Celinski K, et al. Prevalence of spontaneous bacterial peritonitis in asymptomatic inpatients with decompensated liver cirrhosis – a pilot study. Adv Med Sci. 2011;56(1):13-7.
Mostafa MS, El-Seidi EA, Kassem AM, et al. Detection of ascitic fluid infections in patients with liver cirrhosis and ascites. Arab J Gastroenterol. 2011;12(1):20-4.
Heo J, Seo YS, Yim HJ, et al. Clinical features and prognosis of spontaneous bacterial peritonitis in korean patients with liver cirrhosis: a multicenter retrospective study. Gut Liver. 2009;3(3): 197-204.
Coral G, Mattos AA, Damo DF, Viégas AC. Prevalência e prognóstico da peritonite bacteriana espontânea. Experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991- 2000) [Prevalence and prognosis of spontaneous bacterial peritonitis. Experience in patients from a general hospital in Porto Alegre, RS, Brazil (1991-2000)]. Arq Gastroenterol. 2002; 39(3):158-62.
Figueiredo FAF, Coelho HSM, Soares JAS. Peritonite bacteriana espontânea na cirrose hepática: prevalência, fatores preditivos e prognóstico [Spontaneous bacterial peritonitis in hepatic cirrhosis: prevalence,predictive factors and prognosis]. Rev Assoc Med Bras (1992). 1999;45(2):128-36.
Kraja B, Sina M, Mone I, et al. Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis. Gastroenterol Res Pract. 2012;2012:539059.
Liu Y, Pan S, Liu L, et al. A genetic variant in long non-coding RNA HULC contributes to risk of HBV-related hepatocellular carcinoma in a Chinese population. PLoS One. 2012;7(4):e35145.
Zhang S, Ristau JT, Trinh HN, et al. Undertreatment of Asian chronic hepatitis B patients on the basis of standard guidelines: a community- based study. Dig Dis Sci. 2012;57(5):1373-83.
Hur K, Wong M, Lee J, Lee J, Juon HS. Hepatitis B infection in the Asian and Latino communities of Alameda County, California. J Community Health. 2012;37(5):1119-26.
Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006;74(5):756-62.
Costa JS, Silveira MF, Gazalle FK, et al. Consumo abusivo de álcool e fatores associados: estudo de base populacional [Heavy alcohol consumption and associated factors: a population-based study]. Rev Saude Publica. 2004;38(2):284-91.
Reginato TJ, Oliveira MJ, Moreira LC, et al. Characteristics of ascitic fluid from patients with suspected spontaneous bacterial peritonitis in emergency units at a tertiary hospital. Sao Paulo Med J. 2011;129(5):315-9.
Siersema PD, de Marie S, van Zeijl JH, Bac DJ, Wilson JH. Blood culture bottles are superior to lysis-centrifugation tubes for bacteriological diagnosis of spontaneous bacterial peritonitis. J Clin Microbiol. 1992;30(3):667-9.
Shizuma T, Fukuyama N. Investigation into bacteremia and spontaneous bacterial peritonitis in patients with liver cirrhosis in Japan. Turk J Gastroenterol. 2012;23(2):122-6.
Gayatri AA, Suryadharma IG, Purwadi N, Wibawa ID. The relationship between a model of end stage liver disease score (MELD score) and the occurrence of spontaneous bacterial peritonitis in liver cirrhotic patients. Acta Med Indones. 2007;39(2):75-8.
Evans LT, Kim WR, Poterucha JJ, Kamath PS. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology. 2003;37(4):897-901.
Kim JH, Lee JS, Lee SH, et al. The association between the serum sodium level and the severity of complications in liver cirrhosis. Korean J Intern Med. 2009;24(2):106-12.
Guarner C, Solà R, Soriano G, et al. Risk of a first community-acquired spontaneous bacterial peritonitis in cirrhotics with low ascitic fluid protein levels. Gastroenterology. 1999;117(2):414-9.
Such J, Guarner C, Enriquez J, et al. Low C3 in cirrhotic ascites predisposes to spontaneous bacterial peritonitis. J Hepatol. 1988;6(1):80-4.
Girón-González JA, Rodríguez-Ramos C, Elvira J, et al. Serial analysis of serum and ascitic fluid levels of soluble adhesion molecules and chemokines in patients with spontaneous bacterial peritonitis. Clin Exp Immunol. 2001;123(1):56-61.
Coşkun U, Ozenirler S, Sancak B, Bukan N. Serum and ascitic fluid nitrate levels in patients with cirrhosis. Clin Chim Acta. 2001; 306(1-2):127-32.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
