Incidence and predictors of acute oesophageal variceal haemorrhage in patients with spontaneous bacterial peritonitis

Document Type : Original article

Authors

1 Tropical Medicine Department, Mansoura University, Mansoura, Egypt

2 Tropical Medicine Department, Mansoura University, Mansoura, Egypt.

3 Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

4 Faculty of Dentistry, Mansoura University, Mansoura, Egypt

Abstract

Background: Rupture oesophageal varices (REV) is a life-threatening complication of liver cirrhosis. Bacterial infection is linked with the risk of variceal bleeding through complex pathophysiologic pathways. Spontaneous bacterial peritonitis (SBP) is the commonest well-known bacterial infection in patients with cirrhosis. the aim of this study is to estimate the incidence and predictors of REV in cirrhotic patients with SBP.
Patients and methods: 389 patients with cirrhotic ascites out of 2880 patients with ascites and/or acute gastrointestinal bleeding were divided into two groups, group 1 included 189 patients with SBP and group 2 included 200 patients without SBP. Routine clinical and laboratory data were collected. Results: Compared to patients without SBP, patients with SBP had significant higher incidence of oesophageal variceal hemorrhage (25.4% in patients with SBP versus 14% in patients without SBP (P =0.004). multivariate analysis for factors associated with oesophageal variceal haemorrhage in patients with SBP demonstrated that, the independent predictors for rupture oesophageal varices in patients with SBP were, increased age (p value= 0.001) with EXP(B) 1.068; 95.0% C.I. was (1.026-1.113), presence of fever (p value= 0.005) with EXP(B) 3.433; 95.0% C.I. was (1.458-8.083) and hepatic encephalopathy (p value= 0.039) with EXP(B) 3.159; 95.0% C.I. was (1.060-9.421). Conclusion: Spontaneous bacterial peritonitis increases the risk of oesophageal variceal haemorrhage. Increased age, presence of fever and hepatic encephalopathy were independent predictors of acute oesophageal variceal haemorrhage in patients with SBP.

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