Association Between MELD and Spontaneous Bacterial Peritonitis

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Association Between Model for

End-Stage Liver Disease and Spontaneous Bacterial Peritonitis

Authors: Obstein, L; , Mical

S; Reddy, K. Rajende; Yang, Yu-Xiao

Source: The American

Journal of Gastroenterology, Volume 102, Number 12,

December 2007 , pp. 2732-2736(5)

Abstract:

To determine whether a greater Model for

End-Stage Liver Disease (MELD) score is associated with a greater risk of

spontaneous bacterial peritonitis (SBP).

Our METHODS:

retrospective case-control study enrolled 271 consecutive patients with

cirrhosis and ascites who underwent diagnostic paracentesis

upon hospital admission (2002-2005). After excluding immunosuppressed patients, those recently exposed to

antibiotics, those with a potential confounding etiology for ascites, and those

with a prior history of SBP, 111 were included in the study. SBP

was defined as a paracentesis yielding ≥250 neutrophils/mL ascites fluid. Multivariable

logistic regression was performed to determine the odds ratio for the

development of SBP associated with MELD score and grouped MELD score (≤15,

16-24, ≥25). Potential confounders assessed included

age, diabetes mellitus, gender, race, alcohol use, serum sodium, and etiology

of liver disease.

Twenty-nine of 111 

RESULTS: hospitalized patients with

cirrhosis were found to have SBP. Patient

characteristics were similar between groups with and without SBP. The mean MELD score for patients with SBP was 24 and for

those without 18 (P= 0.0003). The odds ratio for developing SBP by each MELD point was

1.11 (1.05-1.19, P= 0.001). Patients with MELD ≥25 had an odds ratio of 9.67

(2.35-39.82, P= 0.002) for SBP,

compared to subjects with MELD ≤15. None of the

potential confounders substantially altered the relationship between MELD and

SBP.

CONCLUSIONS: Increasing MELD score is independently associated with a greater risk of SBP. For every point increase in the MELD score, the risk of

developing SBP increases by 11%. Our finding has

important implications for increasing the suspicion of SBP in patients with

elevated MELD scores.  (Am J Gastroenterol 2007;102:2732-2736)

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