S1145 Outcomes of Patients Hospitalized for Spontaneous Bacterial Peritonitis With Comorbid Irritable Bowel Syndrome

Introduction: Spontaneous bacterial peritonitis (SBP) is a common reason for hospitalization in cirrhotic patients with an associated 30-day mortality rate of 10.8%. The bacterial source for SBP is from the gastrointestinal tract. IBS is a highly prevalent disorder impacting about 11% of patients globally. Studies have demonstrated that IBS may be associated with a higher prevalence of pro-inflammatory bacteria within the gut microbiome. While IBS has been associated with alterations in the gut microflora, its subsequent impact on cirrhotic patients is not well explored. Our study aim is to understand the impact of comorbid IBS on the outcomes of hospitalized patients with SBP. Methods: Hospitalized adults diagnosed with SBP were selected from the 2020 National Inpatient Sample database. International Classification of Diseases-10 codes were used to select diagnoses. Demographic data and outcomes of SBP were compared between a subgroup with IBS, and without IBS. The outcomes of interest were sepsis, acute renal failure (AKI), acute respiratory failure, hypotension/shock, and inpatient mortality. Chi-squared tests and independent t-tests were used to compare proportions and means respectively. A multivariate logistic regression analysis was used to establish if IBS is an independent predictor for the outcomes after adjusting for age, sex, race, and Charlson Comorbidity Index (CCI). Results: For the year 2020, 811,930 hospitalized adults were diagnosed with SBP. Patients with SBP and comorbid IBS were more likely to be women (74% vs 47%, P < 0.001), more likely to be white (83% vs 67%, P < 0.001), have a shorter length of stay (9.7 days vs 11.5 days, P < 0.001), lower hospitalization cost ($29,817 vs $38,195, P < 0.001), and a lower CCI (2.0 vs 2.6, P < 0.001). There was no significant difference in age (58.7 vs 59.3, P = 0.138). IBS was noted to be an independent protective factor for inpatient mortality (adjusted odds ratio (aOR) 0.60, 95% confidence interval (CI): 0.49-0.75, P < 0.001), sepsis (aOR 0.72, 95% CI: 0.65-0.81, P < 0.001), hypotension/shock (aOR 0.80, 95% CI: 0.66-0.97, P = 0.022), acute respiratory failure (aOR 0.67, 95% CI: 0.57-0.77, P < 0.001) and AKI (aOR 0.74, 95% CI: 0.65-0.83), P < 0.001). Conclusion: In hospitalized adults with SBP, our study demonstrates that IBS is a protective a risk factor for sepsis, hypotension/shock, AKI, acute respiratory failure and inpatient mortality. Further randomized studies are needed to evaluate whether this association is due to differences in gut microbiome or other factors.