Tsung‑Hsing Hunga,b, Ping‑Hung Koa, Chih‑Ying Wangc, Chih‑Chun Tsaid, Hsing‑Feng Leea,b*
aDivision of Gastroenterology, Department of Medicine, DalinTzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, cDepartment of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, dDepartment of Mathematics, Tamkang University, New Taipei, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: The impact of hypoalbuminemia on the short‑term and long‑term mortality of cirrhotic patients with spontaneous bacterial peritonitis (SBP), both with and without renal function impairment, remains insufficiently elucidated based on population‑based data. Materials and Methods: We retrieved data from Taiwan’s National Health Insurance Database encompassing 14,583 hospitalized patients diagnosed with both cirrhosis and SBP during the period from January 1, 2010, to December 31, 2013. Prognostic factors influencing 30‑day and 3‑year survival were computed. Furthermore, the impact of hypoalbuminemia on the mortality rate among SBP patients, with or without concurrent renal function impairment, was also assessed. Results: The 30‑day mortality rates for patients with SBP, comparing those with hypoalbuminemia and those without, were 18.3% and 29.4%, respectively (P < 0.001). Similarly, the 3‑year mortality rates for SBP patients with hypoalbuminemia and those without were 73.7% and 85.8%, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for patients’ gender, age, and comorbid conditions, substantiated that individuals with hypoalbuminemia exhibit an inferior 30‑day survival (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.51–1.74, P < 0.001) and reduced 3‑year survival (HR: 1.57, 95% CI: 1.50–1.63, P < 0.001) in comparison to those lacking hypoalbuminemia. Among SBP patients with renal function impairment, those presenting hypoalbuminemia also experienced diminished 30‑day survival (HR: 1.81, 95% CI 1.57–2.07, P < 0.001) as well as reduced 3‑year survival (HR: 1.70, 95% CI 1.54–1.87, P < 0.001). Likewise, in SBP patients without renal function impairment, the presence of hypoalbuminemia was associated with poorer 30‑day survival (HR: 1.54, 95% CI 1.42–1.67, P < 0.001) and 3‑year survival (HR: 1.53, 95% CI 1.46–1.60, P < 0.001). Conclusion: Among cirrhotic patients with SBP, the presence of hypoalbuminemia predicts inferior short‑term and long‑term outcomes, regardless of renal function.
Keywords: Cirrhosis, Hypoalbuminemia, Mortality, Spontaneous bacterial peritonitis
