Factors that predict recurrent spontaneous bacterial peritonitis in cirrhotic patients

Background The recurrence rate of spontaneous bacterial peritonitis (SBP) is increasing in cirrhotic patients. Antibiotic prophylaxis should be prescribed in all cirrhotic patients after the first episode of SBP. However, antibiotics promote the development of antibiotic‐resistant bacteria. Objective To identify the factors that predict the recurrence of SBP after the first episode in cirrhotic patients to optimise the stratification for secondary antibiotic prophylaxis. Methods This retrospective study included 145 cirrhotic patients who had their first SBP episode during 2011‐2015. The 86 patients who survived were divided into either the SBP recurrence or non‐recurrence group according to patient SBP outcome during the 2‐year follow‐up. Demographical, clinical and laboratory parameters were recorded at SBP diagnosis and before hospital discharge. SBP recurrence rate, recurrence‐free survival and in‐hospital mortality were also analysed. Results The recurrence rate of SBP after the first episode was 69.8% (60/86), and the median recurrence‐free survival time was 142 days. The in‐hospital mortality rate was 40.7% (59/145). The significant predictive factors for recurrence of SBP were serum potassium ≥4 mEq/L (HR: 1.89; P  = .028), serum albumin ≤2 g/dL (HR: 2.5; P  = .003) at diagnosis of SBP and platelet count before discharge ≤100 000/microliter (HR: 1.93; P  = .029). Conclusion SBP frequently recurs in cirrhotic patients. Serum potassium ≥4 mEq/L, serum albumin ≤2g/dL at SBP diagnosis and platelet count ≤100 000/microliter before discharge were identified as factors that may predict the recurrence of SBP after the first episode.