Peritonitis risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]

Peritonitis Main Page

Patient Information

Overview

Causes

Classification

Spontaneous Bacterial Peritonitis
Secondary Peritonitis

Differential Diagnosis

Overview

Common risk factors for peritonitis in the development of peritonitis include liver disease, dialysis, and abdominal trauma.

Risk Factors

Biochemical risk factors

Well-established risk factors for developing an initial episode of SBP are :

  • Low ascitic fluid protein level (<1 g/dL)
  • Elevated serum bilirubin level (>4 mg/dL)
  • Advanced Cirrhosis
  • Low levels of 25-hydroxy vitamin D
  • Serum albumin level <2.85 g/dL

Clinical risk factors

  • Patients with Vatical hemorrhage and GI bleeding associated with Cirrhosis are more prone to develop SBP irrespective of the presence of ascites.

Genetic risk factors

  • The Toll-like receptor 2 (TLR2) proteins[1] variants of the NOD2 (nucleotide-binding oligomerisation domain containing gene and Farnesoid X were known to cause SBP.

Pharmacological risk factors

  • Proton pump inhibitors (PPI) has been associated with a three-fold increase in the risk and identified as an independent risk factor for SBP in patients with advanced cirrhosis.
  • Beta-adrenergic antagonists namely nonselective beta-blocker (NSBB) therapy was found to be protective for SBP.

Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites.[2]

  • Low serum sodium levels
  • Child-Pugh stage C
  • Elevated ascites PMN counts (≥100 cells/μl)
  • MELD≥22
  • Elevated CRP levels

Common risk factors for peritonitis are described as follows:[3]

Primary Peritonitis Secondary Peritonitis Tertiary Peritonitis
  • Cirrhosis with ascitis
  • Portal hypertension with ascitis
  • Patient with continuous ambulatory peritoneal dialysis (CAPD)
  • Ruptured gastric ulcer, appendicular abscess or diverticular abscess
  • Inflamatory bowel diseases such as chron's disease or ulcerative colitis with toxic megacolon
  • Pelvic inflamatory disease
  • Recent surgical procedures
  • Recent trauma to the abdomen (e.g. Stab injury or gun shot injury)
  • Previous history of severe antibiotic use
  • Treatment failure in patients with primary or secondary peritonitis

References

  1. Nischalke HD, Berger C, Aldenhoff K, Thyssen L, Gentemann M, Grünhage F; et al. (2011). "Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis". J Hepatol. 55 (5): 1010–6. doi:10.1016/j.jhep.2011.02.022. PMID 21356257.
  2. Schwabl P, Bucsics T, Soucek K, Mandorfer M, Bota S, Blacky A; et al. (2015). "Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites". Liver Int. 35 (9): 2121–8. doi:10.1111/liv.12795. PMID 25644943.
  3. Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE et al. (2016) ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 36 (5):481-508. DOI:10.3747/pdi.2016.00078 PMID: 27282851

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