From the Research
Systolic blood pressure (SBP) calculations should not be used as votes in the context of spontaneous bacterial peritonitis (SBP) diagnosis or management, as the provided evidence does not support this approach for SBP. When evaluating a patient's risk for SBP, I recommend considering the presence of ascites, abdominal pain, fever, or altered mental status in a patient with known liver disease, as these are common presentations of SBP 1. The diagnosis of SBP is typically made by paracentesis, with an ascites absolute neutrophil count (ANC) ≥ 250 cells/mm3 being diagnostic 1.
Key Considerations for SBP Diagnosis and Management
- The most common cause of SBP is Gram-negative bacteria, but infections due to Gram-positive bacteria and multidrug-resistant bacteria are increasing 1, 2.
- Paracentesis is the diagnostic modality of choice and should be performed in any patient with ascites and concern for SBP or upper gastrointestinal bleeding, or in those being admitted for a complication of cirrhosis 1, 3.
- Management traditionally includes a third-generation cephalosporin, but specific patient populations may require more broad-spectrum coverage with a carbapenem or piperacillin-tazobactam 1, 4.
- Albumin infusion is associated with reduced risk of renal impairment and mortality in patients with SBP 1, 4.
Prioritizing Morbidity, Mortality, and Quality of Life
In the context of SBP, prioritizing morbidity, mortality, and quality of life requires prompt and effective treatment, as well as consideration of the patient's underlying liver disease and other comorbidities 5. The use of SBP calculations as votes is not a recommended approach in this context, and instead, clinicians should focus on established diagnostic and treatment guidelines. By prioritizing evidence-based management and considering the individual patient's needs and risk factors, clinicians can improve outcomes and reduce the risk of morbidity and mortality in patients with SBP.