The presence of echocardiographic abnormalities increases mortality in patients with spontaneous bacterial peritonitis

M Mandorfer; S Bota; P Schwabl; T Bucsics; N Pfisterer; G Goliasch; V Fuhrmann; T Horvatits; A Ferlitsch; W Sieghart; M Trauner; M Peck-Radosavljevic; T Reiberger

doi:10.1055/s-0035-1551739

Zeitschrift für Gastroenterologie, Table of Contents

The presence of echocardiographic abnormalities increases mortality in patients with spontaneous bacterial peritonitis

M Mandorfer ¹, S Bota ¹, P Schwabl ¹, T Bucsics ¹, N Pfisterer ¹, G Goliasch ¹, V Fuhrmann ¹, T Horvatits ¹, A Ferlitsch ¹, W Sieghart ¹, M Trauner ¹, M Peck-Radosavljevic ¹, T Reiberger ¹

¹Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria

Abstract

Background: Cirrhosis was found to be associated with echocardiographic abnormalities (ECHOABN) such as left ventricular hypertrophy (LVH), systolic dysfunction (LVSD) and diastolic dysfunction (LVDD), as well as left atrial enlargement (LAE). Recent studies have highlighted the importance of the cardiac reserve for the adaptive response to acute circulatory stress in advanced cirrhosis, e.g. in patients with infections such as spontaneous bacterial peritonitis (SBP).

Aim: To assess the impact of abnormalities in cardiac structure and function in routine echocardiography on mortality in patients with cirrhosis and ascites (A) without SBP and (B) after a SBP episode.

Methods: One hundred twenty-seven patients with cirrhosis who underwent their first paracentesis at the Medical University of Vienna and did not develop SBP during the follow-up (group: no-SBP), as well as 78 patients diagnosed with SBP (group: SBP) with available information on routine echocardiography were included in this retrospective cohort study. Cox models were calculated to investigate the effect of echocardiographic abnormalities on transplant-free survival (TFS) and adjusted for potential confounding variables.

Results: The prevalence of significant ECHOABNs was: LVH: 20%, LVSD: 2%, LVDD: 16%, and LAE: 18%. The proportion of patients with ECHOABNs in the SBP group (55%) was higher, when compared to no-SBP patients (37%; P= 0.011).

While the presence of ECHOABNs had no impact on TFS in the no-SBP group (hazard ratio (HR): 1.183, 95% confidence interval (95% CI): 0.711 – 1.969; P= 0.776), it was associated with substantially increased mortality in the SBP group (HR: 1.914, 95% CI: 1.026 – 3.571; P= 0.041).

Conclusions: The prevalence of ECHOABNs in patients with cirrhosis and ascites is high and further increases in patients with more advanced stages of cirrhosis, such as patients with SBP. Development of SBP may reveal impairments in the adaptive response to acute circulatory stress due to latent cardiac dysfunction, as the presence of ECHOABNs was associated with increased mortality in this subgroup of patients.