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Multivariate predictive model for asymptomatic spontaneous bacterial peritonitis in patients with liver cirrhosis

查看全文 作　　者：Bo [1]Tu;Yue-Ning [2]Zhang;Jing-Feng [3]Bi;Zhe [1]Xu;Peng [1]Zhao;Lei [1]Shi;Xin [1]Zhang;Guang [1]Yang;En-Qiang [1]Qin 高影响力作者 机构地区：[1]Department of Infectious Disease,the Fifth Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100039,China;[2]Center of Hepatology and Gastroenterology,Beijing Capital Medical University You’an Hospital,Beijing 100039,China;[3]Department of Clinical and Translational Medicine,the Fifth Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100039,China高影响力机构 出　　处：《World Journal of Gastroenterology》索引2020年第26卷第29期,共11页高影响力期刊 基　　金：Supported by the Digestive Medical Coordinated Development Center of Beijing Municipal Administration,No.XXZ0403. 摘　　要：BACKGROUNDSpontaneous bacterial peritonitis (SBP) is a detrimental infection of the asciticfluid in liver cirrhosis patients, with high mortality and morbidity. Earlydiagnosis and timely antibiotic administration have successfully decreased themortality rate to 20%-25%. However, many patients cannot be diagnosed in theearly stages due to the absence of classical SBP symptoms. Early diagnosis ofasymptomatic SBP remains a great challenge in the clinic.AIMTo establish a multivariate predictive model for early diagnosis of asymptomaticSBP using positive microbial cultures from liver cirrhosis patients with ascites.METHODSA total of 98 asymptomatic SBP patients and 98 ascites liver cirrhosis patients withnegative microbial cultures were included in the case and control groups,respectively. Multiple linear stepwise regression analysis was performed toidentify potential indicators for asymptomatic SBP diagnosis. The diagnosticperformance of the model was estimated using the receiver operatingcharacteristic curve.RESULTSPatients in the case group were more likely to have advanced disease stages,cirrhosis related-complications, worsened hematology and ascites, and higher mortality. Based on multivariate analysis, the predictive model was as follows: y (P) = 0.018 + 0.312 × MELD (model of end-stage liver disease) + 0.263 × PMN(ascites polymorphonuclear) + 0.184 × N (blood neutrophil percentage) + 0.233 ×HCC (hepatocellular carcinoma) + 0.189 × renal dysfunction. The area under thecurve value of the established model was 0.872, revealing its high diagnosticpotential. The diagnostic sensitivity was 73.5% (72/98), the specificity was 86.7%(85/98), and the diagnostic efficacy was 80.1%.CONCLUSIONOur predictive model is based on the MELD score, polymorphonuclear cells,blood N, hepatocellular carcinoma, and renal dysfunction. This model mayimprove the early diagnosis of asymptomatic SBP. 关 键 词：Spontaneous bacterial peritonitis ASYMPTOMATIC ASCITES Multivariate predictive model Liver cirrhosis
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