Factors associated with refractory ascites and spontaneous bacterial peritonitis in a predominantly Hispanic population: A retrospective analysis.

Abstract

Background: Refractory ascites (RA) and spontaneous bacterial peritonitis (SBP) are severe complications of decompensated cirrhosis, contributing to high morbidity and mortality. RA develops when ascites persists despite maximum diuretic therapy, while SBP arises from bacterial translocation and immune dysfunction in cirrhotic patients with ascites. Identifying key risk factors associated with these conditions is crucial for early intervention and improved patient outcomes.

Aim: To assess clinical and biochemical predictors of RA and SBP in a cohort of hospitalized patients with cirrhotic ascites.

Methods: A retrospective chart review was conducted on patients with cirrhotic ascites diagnosed with RA or SBP at University Medical Center, El Paso, from July 1, 2013 to December 31, 2023. Patient demographics, clinical history, laboratory parameters, ascitic fluid analysis, and cirrhosis severity scores [Model for End-Stage Liver Disease-Sodium (MELD-Na) and Child-Pugh] were recorded. Statistical analyses, including multivariate logistic regression, were performed to identify independent predictors of RA and SBP, with a significance threshold of P < 0.05.

Results: A total of 179 patients were included, with a mean age of 59.08 ± 13.04 years, predominantly male (55.9%) and Hispanic (98.3%). The most common etiology of cirrhosis was alcohol-related liver disease (45.3%), and most patients had Grade III ascites (95.5%). Among them, 115 (64.2%) had RA, and 57 (31.8%) had SBP. RA was significantly associated with abnormal serum potassium levels [odds ratio (OR) = 2.27, 95%CI: 1.06-4.84, P = 0.034], while SBP was independently predicted by gastrointestinal bleeding (OR = 2.59, 95%CI: 1.18-5.64, P = 0.017) and thrombocytopenia (platelet count < 50000; OR = 3.27, 95%CI: 1.08-9.88, P = 0.035).

Conclusion: RA and SBP are major complications of cirrhosis, with electrolyte imbalances and coagulopathy playing key roles in their development. Our study confirms that abnormal potassium levels significantly predict RA, while gastrointestinal bleeding and thrombocytopenia are strong predictors of SBP. These findings emphasize the need for early risk stratification and targeted management strategies to improve outcomes in high-risk cirrhotic patients, particularly in minority populations with limited healthcare access. Further prospective studies are warranted to validate these results and explore potential interventions to reduce RA and SBP incidence.