Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2020; 26(29): 4316-4326
Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4316
Multivariate predictive model for asymptomatic spontaneous bacterial peritonitis in patients with liver cirrhosis
Bo Tu, Yue-Ning Zhang, Jing-Feng Bi, Zhe Xu, Peng Zhao, Lei Shi, Xin Zhang, Guang Yang, En-Qiang Qin
Bo Tu, Zhe Xu, Peng Zhao, Lei Shi, Xin Zhang, Guang Yang, En-Qiang Qin, Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
Yue-Ning Zhang, Center of Hepatology and Gastroenterology, Beijing Capital Medical University You’an Hospital, Beijing 100039, China
Jing-Feng Bi, Department of Clinical and Translational Medicine, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100039, China
Author contributions: Tu B designed and performed the research and wrote the paper; Zhang YN designed the research and supervised the report, and contributed equally as the first author; Bi JF and Xu Z performed the research and contributed to the analysis; Zhao P, Shi L, Zhang X and Yang G performed the research and provided clinical advice; Qin EQ designed the research and supervised the report.
Supported by the Digestive Medical Coordinated Development Center of Beijing Municipal Administration, No. XXZ0403.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Chinese People's Liberation Army General Hospital.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: En-Qiang Qin, MD, Chief Physician, Department of Infectious Disease, the Fifth Medical Center, Chinese People's Liberation Army General Hospital, 100 Western 4th Ring Middle Road, Beijing 100039, China. qeq2004@sina.com
Received: March 4, 2020
Peer-review started: March 4, 2020
First decision: April 12, 2020
Revised: June 2, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: August 7, 2020
Abstract
BACKGROUND

Spontaneous bacterial peritonitis (SBP) is a detrimental infection of the ascitic fluid in liver cirrhosis patients, with high mortality and morbidity. Early diagnosis and timely antibiotic administration have successfully decreased the mortality rate to 20%-25%. However, many patients cannot be diagnosed in the early stages due to the absence of classical SBP symptoms. Early diagnosis of asymptomatic SBP remains a great challenge in the clinic.

AIM

To establish a multivariate predictive model for early diagnosis of asymptomatic SBP using positive microbial cultures from liver cirrhosis patients with ascites.

METHODS

A total of 98 asymptomatic SBP patients and 98 ascites liver cirrhosis patients with negative microbial cultures were included in the case and control groups, respectively. Multiple linear stepwise regression analysis was performed to identify potential indicators for asymptomatic SBP diagnosis. The diagnostic performance of the model was estimated using the receiver operating characteristic curve.

RESULTS

Patients in the case group were more likely to have advanced disease stages, cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN (ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 × HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under the curve value of the established model was 0.872, revealing its high diagnostic potential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7% (85/98), and the diagnostic efficacy was 80.1%.

CONCLUSION

Our predictive model is based on the MELD score, polymorphonuclear cells, blood N, hepatocellular carcinoma, and renal dysfunction. This model may improve the early diagnosis of asymptomatic SBP.

Keywords: Spontaneous bacterial peritonitis, Asymptomatic, Ascites, Multivariate predictive model, Liver cirrhosis

Core tip: This retrospective study established a multivariate diagnostic model for asymptomatic spontaneous bacterial peritonitis in liver cirrhosis patients with ascites. The multivariate predictive model constructed by multiple linear stepwise regression analysis was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN (ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 × HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The diagnostic efficacy of the model was 80.1%, sensitivity was 73.5% and specificity was 86.7%. This model may improve the early diagnosis of asymptomatic spontaneous bacterial peritonitis.