Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis

Rashid Khan, Sujan Ravi, Sakkarin Chirapongsathorn, Whitney Jennings, Habeeb Salameh, Kirk Russ, Matt Skinner, Sandhya Mudumbi, Douglas Simonetto, Yong Fang Kuo, Patrick S. Kamath, Ashwani K. Singal

Research output: Contribution to journalArticle

Abstract

Objective: To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode. Methods: A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode. Results: Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11). Conclusion: Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.

Original languageEnglish (US)
Pages (from-to)1799-1806
Number of pages8
JournalMayo Clinic Proceedings
Volume94
Issue number9
DOIs
StatePublished - Sep 1 2019

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End Stage Liver Disease
Peritonitis
Fibrosis
Ascites
Ascitic Fluid
Sampling Studies
Medical Records
Case-Control Studies
Proteins
Hospitalization
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Medicine(all)

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Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis. / Khan, Rashid; Ravi, Sujan; Chirapongsathorn, Sakkarin; Jennings, Whitney; Salameh, Habeeb; Russ, Kirk; Skinner, Matt; Mudumbi, Sandhya; Simonetto, Douglas; Kuo, Yong Fang; Kamath, Patrick S.; Singal, Ashwani K.

In: Mayo Clinic Proceedings, Vol. 94, No. 9, 01.09.2019, p. 1799-1806.

Research output: Contribution to journalArticle

Khan, R, Ravi, S, Chirapongsathorn, S, Jennings, W, Salameh, H, Russ, K, Skinner, M, Mudumbi, S, Simonetto, D, Kuo, YF, Kamath, PS & Singal, AK 2019, 'Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis', Mayo Clinic Proceedings, vol. 94, no. 9, pp. 1799-1806. https://doi.org/10.1016/j.mayocp.2019.02.027
Khan, Rashid ; Ravi, Sujan ; Chirapongsathorn, Sakkarin ; Jennings, Whitney ; Salameh, Habeeb ; Russ, Kirk ; Skinner, Matt ; Mudumbi, Sandhya ; Simonetto, Douglas ; Kuo, Yong Fang ; Kamath, Patrick S. ; Singal, Ashwani K. / Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 9. pp. 1799-1806.
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title = "Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis",
abstract = "Objective: To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode. Methods: A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode. Results: Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94{\%}, 89{\%}, and 100{\%} at three respective centers. In the pooled sample, probability of SBP was 11{\%}, 31{\%}, 71{\%}, and 93{\%} at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95{\%} CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11). Conclusion: Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.",
author = "Rashid Khan and Sujan Ravi and Sakkarin Chirapongsathorn and Whitney Jennings and Habeeb Salameh and Kirk Russ and Matt Skinner and Sandhya Mudumbi and Douglas Simonetto and Kuo, {Yong Fang} and Kamath, {Patrick S.} and Singal, {Ashwani K.}",
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T1 - Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis

AU - Khan, Rashid

AU - Ravi, Sujan

AU - Chirapongsathorn, Sakkarin

AU - Jennings, Whitney

AU - Salameh, Habeeb

AU - Russ, Kirk

AU - Skinner, Matt

AU - Mudumbi, Sandhya

AU - Simonetto, Douglas

AU - Kuo, Yong Fang

AU - Kamath, Patrick S.

AU - Singal, Ashwani K.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective: To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode. Methods: A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode. Results: Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11). Conclusion: Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.

AB - Objective: To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode. Methods: A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode. Results: Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11). Conclusion: Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.

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