Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis

Carole Ruault (1) , Nathalie Zappella (2) , Julien Labreuche (3, 4) , Pierrick Cronier (5) , Baptiste Claude (6) , Marc Garnier (7, 8) , Antoine Vieillard-Baron (9) , Sofia Ortuno (10) , Maxime Mallet (11) , Olga Cosic (12) , Laura Crosby (13) , Olivier Lesieur , Nicolas Pichon (14) , Arnaud Galbois (15) , Cedric Bruel (16) , Kenneth Ekpe (17) , Bertrand Sauneuf (18) , Damien Roux (19) , Stephane Legriel (1, 20)

1 CHV - Centre Hospitalier de Versailles André Mignot
2 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
3 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 Centre Hospitalier Sud Francilien
6 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
7 GRC 29 - ARPE - Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire
8 CHU Tenon [AP-HP]
9 Hôpital Ambroise Paré [AP-HP]
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 CHU Pitié-Salpêtrière [AP-HP]
12 HNFC - Hôpital Nord Franche-Comté [Hôpital de Trévenans]
13 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
14 CHU Limoges
15 Ramsay Générale de Santé - Hôpital Privé La Louvière
16 Centre hospitalier Saint-Joseph [Paris]
17 AP-HP - Hopital Saint-Louis [AP-HP]
18 CHPC - CH Centre Hospitalier Public du Cotentin
19 Hôpital Louis Mourier - AP-HP [Colombes]
20 CESP - Centre de recherche en épidémiologie et santé des populations

Ascitic fluid infection (AFI) is a life-threatening complication of cirrhosis. We aimed to identify early indicators of secondary peritonitis (SP), which requires emergency surgery, and to describe the outcomes of SP and spontaneous bacterial/fungal peritonitis (SBFP). Adults with cirrhosis and AFI admitted to 16 university or university-affiliated ICUs in France between 2002 and 2017 were studied retrospectively. Cases were identified by searching the hospital databases for relevant ICD-10 codes and hospital charts for AFI. Logistic multivariate regression was performed to identify factors associated with SP. Secondary outcomes were short-and long-term mortality and survivors' functional outcomes. Of 178 included patients (137 men and 41 women; mean age, 58 ± 11 years), 21 (11.8%) had SP, confirmed by surgery in 16 cases and by abdominal computed tomography in 5 cases. Time to diagnosis exceeded 24 h in 7/21 patients with SP. By multivariate analysis, factors independently associated with SP were ascitic leukocyte count > 10,000/mm 3 (OR 3.70; 95%CI 1.38-9.85; P = 0.009) and absence of laboratory signs of decompensated cirrhosis (OR 4.53; 95%CI 1.30-15.68; P = 0.017). The 1-year mortality rates in patients with SBFP and SP were 81.0% and 77.5%, respectively (Logrank test, P = 0.92). Patients with SP vs. SBFP had no differences in 1-year functional outcomes. This multicenter retrospective study identified two indicators of SP as opposed to SBFP in patients with cirrhosis. Using these indicators may help to provide early surgical treatment.

Mots clés: Digestive signs and symptoms; Liver

Domaines: Médecine humaine et pathologie

Carole Ruault, Nathalie Zappella, Julien Labreuche, Pierrick Cronier, Baptiste Claude, et al.. Identifying early indicators of secondary peritonitis in critically ill patients with cirrhosis. Scientific Reports, 2021, 11 (1), ⟨10.1038/s41598-021-00629-4⟩. ⟨hal-03408884⟩