Emergency department predictors and early outcomes of spontaneous bacterial peritonitis in cirrhotic patients with ascites: Unraveling the acute crisis

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in cirrhotic patients with ascites, often presenting acutely in the emergency department (ED). Early recognition of SBP and timely intervention are critical to improving short-term outcomes. This study aims to identify clinical and laboratory predictors of SBP outcomes in cirrhotic patients with ascites presenting to the ED. Methods: The study included 140 cirrhotic patients with ascites admitted to the ED with suspected SBP. Data on demographic char-acteristics, comorbidities, clinical presentation, laboratory findings, and severity scores were collected. We assessed short-term outcomes, including in-hospital mortality, ICU admission and length of hospital stay. Multivariate logistic regression was performed to identify predictors of mortality. Propensity score matching was used to account for conf-ounding factors and the concordance index (C-index) was used to measure the performance of the model. Results: The commonest presenting symptoms were fever (61.4%), abdomi-nal pain and guard (72.9%), confusion/disorientation (24.3%), and hypotension (21.4%). The multivariate analysis identified chronic kidney disease (CKD), hypotension and MELD score, as significant predictors of 30-day mortality. The propensity score stratification revealed higher mortality rates in patients with elevated MELD scores and CKD and hypotension. The model diagnostic statistics for the Cox proportional hazards model revealed a C-index of 0.74, indicating a moderately strong discriminatory ability of the model. Conclusion: SBP is a significant cause of mortality in cirrhotic patients with ascites. Early identification of risk factors of SBP in the ED can help predict short-term outcomes and guide management in the ED.