Spontaneous bacterial peritonitis and associated factors among patients with cirrhotic ascites attending public hospitals in Harari region, eastern Ethiopia.

Abstract

Objectives: Spontaneous bacterial peritonitis is a potentially fatal complication and a serious sequel occurring in patients with cirrhotic ascites. Although the complications of cirrhotic ascites are high and lethal, there was limited information on the burden and risk factors of spontaneous bacterial peritonitis in Ethiopia and the study setting. Our study aims to determine the prevalence of spontaneous bacterial peritonitis and associated factors among patients with cirrhotic ascites attending public hospitals in Harari region, eastern Ethiopia, from December 15 to 31, 2022.

Methods: An institution-based retrospective cross-sectional study was conducted among randomly selected 319 patients with cirrhotic ascites attending public hospitals in Harari region from January 1, 2021 to December 15, 2022. Data were extracted from individual medical records, patient cards, and follow-up charts using a semi-structured questionnaire/checklist. Data were entered using EpiData version 3.1 and analyzed using the Statistical Package for Social Science version 22. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with spontaneous bacterial peritonitis. An adjusted odds ratio (with 95% confidence interval) was used to report the adjusted association, and statistical significance was declared at p < 0.05.

Results: The prevalence of spontaneous bacterial peritonitis was 34.8% (95% confidence interval: 30.1%-40.2%). In this study, gastrointestinal bleeding (adjusted odds ratio = 1.99 (1.13-3.50)), alcohol intake (adjusted odds ratio = 2.17 (1.02-4.65)), hepatitis infection (adjusted odds ratio = 1.95 (1.09-3.46)), serum electrolytes abnormalities (adjusted odds ratio = 6.36 (3.61-11.23)), and low peritoneal fluid protein (adjusted odds ratio = 4.52 (2.51-8.12)) were important factors associated with spontaneous bacterial peritonitis.

Conclusions: More than one out of three patients with cirrhotic ascites had spontaneous bacterial peritonitis in eastern Ethiopia. In this study, alcohol intake, gastrointestinal bleeding, hepatitis, electrolyte imbalances, and low levels of peritoneal fluid protein were predictors of spontaneous bacterial peritonitis. Reducing alcohol intake, preventing hepatitis infection and cirrhotic complications, and managing serum electrolytes and peritoneal fluid protein levels would be essential to prevent and reduce the risks of spontaneous bacterial peritonitis and its lethal consequences. Therefore, a prospective large-scale study is crucial to understanding the burden and associated factors with spontaneous bacterial peritonitis in patients with cirrhotic ascites. Furthermore, improving access to diagnostic tools such as ultrasound in local health facilities and providing short training for local health providers to guide early diagnosis and treatment of spontaneous bacterial peritonitis.