A253 PRIMARY PROPHYLAXIS FOR SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED CIRRHOTIC PATIENTS WITH LOW PROTEIN ASCITES AND RENAL DYSFUNCTION OR LIVER FAILURE: A RETROSPECTIVE REVIEW FROM A TERTIARY CENTRE IN BRITISH COLUMBIA
Notice bibliographique
Résumé
Abstract Background Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection that can occur in patients with cirrhosis and ascites. The benefits of primary prophylaxis with antibiotics for SBP have been demonstrated in patients with cirrhosis presenting with gastrointestinal (GI) bleeding; patients hospitalized for other reasons with an ascitic protein less than 10 g/L; and patients with ascitic protein less than 15 g/L with either impaired renal function (serum creatinine greater than 106 µmol/L, BUN greater than 8.9 mmol/L, or serum sodium less than or equal to 130 mEq/L) or liver failure (Child-Pugh score greater than or equal to 9 or bilirubin greater than 50 umol/L). Purpose To evaluate the rate of primary prophylaxis in patients discharged from a tertiary care hospital with low protein ascites and impaired renal function or liver failure, and subsequent episodes of SBP, hospitalizations, or deaths. Method A retrospective chart review at St. Paul’s Hospital in Vancouver, British Columbia, from November 2019 to August 2021 was conducted. Hospitalized patients with cirrhosis who had an ascitic protein less than 15 g/L and met criteria for either renal dysfunction or liver failure were included in the study. The rate of primary prophylaxis prescribed in eligible patients as well as the subsequent incidence of SBP, hospitalizations, or all-cause mortality were evaluated. Patients were followed up to 12 months after the index paracentesis. Result(s) A total of 279 patients with cirrhosis were hospitalized during the study period. 69 patients underwent a diagnostic paracentesis and 41 patients met the inclusion criteria for primary SBP prophylaxis. 28 patients were excluded with most common reasons being ascitic protein above 15 g/L (n=12), no documented ascitic protein concentration (n=9), or index paracentesis met the criteria for the diagnosis of SBP (n=5). Of the patients included, 37 (90.2%) did not receive primary prophylaxis. 8 of these patients (21.6%) developed subsequent SBP. 30 patients (81.1%) were hospitalized at least once in the following 12 months. 18 (48.6%) died during the follow-up period with 1 death attributed to SBP. 4 patients (9.76%) received primary prophylaxis and were prescribed either ciprofloxacin or trimethoprim/sulfamethoxazole. None of these patients developed SBP, however, 3 (75%) were hospitalized and died from other causes. Conclusion(s) The rate of primary prophylaxis for SBP in hospitalized patients with low protein ascites and impaired renal function or liver failure at our institution is low. The guarded prognosis in this subset of patients is also demonstrated. Further studies are needed to assess the root causes for the lack of primary prophylaxis given. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,003 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».