[Predictors of short-term antimicrobial treatment outcomes in patients with liver failure complicated by spontaneous bacterial peritonitis: A retrospective study].

Authors

Yangmei Zhou, Duoduo Li, Limin Chen, Zhenguo Liu, Pengcheng Zhou

Published in

Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. Volume 51. Issue 4. Pages 720-728. Apr 28, 2026.

Abstract

Spontaneous bacterial peritonitis (SBP) is a common complication of liver failure and is associated with high mortality. This study aims to identify factors associated with the effectiveness of antimicrobial therapy in patients with liver failure complicated by SBP, thereby providing clinical evidence for individualized antibiotic selection.
In this retrospective study, the short-term antimicrobial treatment outcomes of 263 patients with liver failure complicated by SBP admitted to 2 tertiary teaching hospitals in China between 2015 and 2021 were analyzed. According to the initial antimicrobial regimen, patients were divided into three groups: the third-generation cephalosporin (TGC) group, the β-lactam/β-lactamase inhibitor combination group, and the carbapenem group. Based on short-term treatment outcomes, patients were further classified into an improvement group or a deterioration group. Baseline clinical characteristics (including age, sex, and etiologies of liver failure), changes in laboratory parameters before and after treatment (including complete blood count, liver function indices, and coagulation parameters), and short-term treatment outcomes (improvement or deterioration) were compared among the three antimicrobial treatment groups. Differences in baseline laboratory parameters between the improvement and deterioration groups were also analyzed. A binary Logistic regression model was established to identify independent factors associated with treatment outcomes, followed by subgroup analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of these factors, and the area under the curve (AUC) and model prediction accuracy were calculated.
A total of 263 patients were included, comprising 52 patients (19.8%) in the TGC group, 138 patients (52.5%) in the β-lactam/β-lactamase inhibitor combination group, and 73 patients (27.8%) in the carbapenem group. No significant differences were observed among the three groups regarding treatment outcomes or post-treatment biochemical parameters (all P>0.05). Compared with the improvement group (172 patients, 65.4%), the deterioration group (91 patients, 34.6%) had significantly higher levels of total bilirubin (P=0.012), direct bilirubin (P=0.045), prothrombin time (PT) (P=0.015), and international normalized ratio (INR) (P=0.044), as well as significantly lower hemoglobin concentrations (P=0.009) and prothrombin activity (PTA) (P=0.034). Logistic regression analysis demonstrated that hemoglobin concentration (OR=0.982, P=0.006) was an independent protective factor for treatment efficacy, whereas prothrombin time (OR=1.051, P=0.002) was an independent risk factor. The predictive model achieved an accuracy of 68.1% and an AUC of 0.651. Subgroup analysis showed that among patients with 30%≤PTA<40%, carbapenem therapy was associated with better treatment outcomes than other antibiotic regimens.
PTA and hemoglobin concentration are important predictors of short-term antimicrobial treatment outcomes in patients with liver failure complicated by SBP. Among these, PTA may provide useful guidance for the rational selection of antibiotics in clinical practice.

PMID:
42394494
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.

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