Echocardiographic and Electrocardiographic Predictors of Adverse Outcomes in Spontaneous Bacterial Peritonitis.
Publication/Presentation Date
12-2017
Abstract
Background
Patients with cirrhosis who develop spontaneous bacterial peritonitis (SBP) suffer from cirrhotic cardiomyopathy which is characterized by impaired contractility in response to stress despite a relatively normal resting cardiac output. We hypothesized that electrocardiographic and echocardiographic information would help prognosticate patients developing SBP in addition to existing scoring systems.
Methods
Cirrhotic patients admitted to Einstein Medical Center from 01/01/2005 to 6/30/2012 for SBP, and did not receive a transplant within one year, were included. Patients were classified as QTc low vs. high, and E/E’ low vs. high at cut points ≥480 msec for QTc and ≥10 for E/E’ ratio. We estimated 1 year survival using Kaplan Meier curves. Regression analysis and Cox proportional hazards model were used for QTc and E/E’ ratio respectively for assessing 1 year survival.
Results
Among 112 patients with electrocardiogam, 78 were classified as QTc low. Among 64 patients with echocardiograms, 23 were classified as E/E’ low. Higher QTc was associated with increased in-hospital acute kidney injury. QTc and E/E’ ratio predicted worse 1 year survival (HR = 2.16, 95% CI 1.29-3.49; HR 2.65, 95% CI 1.31-5.35, respectively) on univariate and multivariate analysis (OR = 1.02, 95% CI 1.01-1.03; HR = 3.26, 95% CI 1.22-9.82 respectively) after adjusting for both Child Pugh stage, MELD score among other risk factors.
Conclusion
In conclusion, cirrhotic patients with SBP who present with a prolonged QTc interval are at a greater risk for acute renal failure during hospitalization. High QTc duration and an E/E’ ratio of ≥10 independently predict increased mortality at 1-year follow-up.
Volume
7
Issue
4
First Page
321
Last Page
327
Published In/Presented At
Shah, M. Patnaik, S. Maludum, O. Patil, S. De Venecia, T. A., Figueredo, V. M. (2017). Echocardiographic and Electrocardiographic Predictors of Adverse Outcomes in Spontaneous Bacterial Peritonitis. Journal of Clinical and Experimental Hepatology. 7(4), 321-327. https://doi.org/10.1016/j.jceh.2017.05.007
Disciplines
Medicine and Health Sciences
PubMedID
29234197
Department(s)
Department of Medicine, Cardiology Division, Department of Medicine Faculty
Document Type
Article