Survival After Spontaneous Bacterial Peritonitis in Cirrhosis
Patients with cirrhosis who develop spontaneous bacterial peritonitis have a median survival of approximately 142-289 days (roughly 5-9 months), with 1-year survival of only 30-34%.
Short-Term Mortality
The immediate prognosis following SBP is grave, with mortality occurring in distinct phases:
- In-hospital mortality: Approximately 20% despite appropriate antibiotic treatment and infection resolution 1
- 30-day mortality: 26% in recent studies 2
- 3-month mortality: 50.7% 2
- 6-month survival: Only 30.8% of patients remain alive 3
- 1-year survival: 30-34% 1, 3
Median Survival Time
The median transplant-free survival after first SBP episode ranges from 142 to 289 days (approximately 5 to 9.5 months) 4, 5. This represents the point at which half of patients have died or required liver transplantation.
Factors That Worsen Survival
Certain clinical scenarios dramatically shorten expected survival:
- Treatment-resistant SBP: Failure to respond to first-line antibiotics significantly worsens mortality 4
- Recurrent SBP: Occurs in 44-70% of survivors, with median recurrence-free survival of only 142 days 5, 3
- Delayed treatment: Each hour of delay in diagnostic paracentesis increases in-hospital mortality by 3.3% 1, 6
- High MELD score: MELD ≥20.5 predicts 30-day mortality with 83.3% sensitivity 2
- Renal dysfunction: Creatinine ≥1.5 mg/dL increases mortality risk 3.2-fold 6
- Elevated INR: Reflects advanced liver dysfunction and independently predicts death 3
Critical Pitfall
The development of SBP should trigger immediate liver transplant evaluation if not already completed, as this complication signals end-stage liver disease with limited survival without transplantation 1. The poor prognosis is fundamentally related to the severity of underlying cirrhosis rather than the infection itself 3.
Long-Term Outlook
Even among the minority who survive the initial hospitalization:
- Recurrence is the rule, not the exception: 44-70% will develop recurrent SBP 5, 3
- Progressive liver failure: The underlying cirrhosis continues to deteriorate 4
- Indefinite antibiotic prophylaxis required: All survivors need long-term antibiotics until transplantation or death 1
The sobering reality is that SBP represents a sentinel event marking transition to end-stage liver disease, with most patients dying within one year unless they receive liver transplantation 1, 4.