中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 6
Jun.  2022
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(6): 1311-1316

Association of energy metabolic markers with the short-term risk of spontaneous bacterial peritonitis in patients with decompensated hepatitis B virus-related liver cirrhosis

DOI: 10.3969/j.issn.1001-5256.2022.06.018

  • Department of Severe Liver Diseases, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou 350025, China

Research funding:

Fujian Medical Innovation Program (2020CXB038);

Science and Technology Program of Fuzhou City (2021-S-240)

More Information
  • Corresponding author: GAO Haibing, gaohb605@163.com (ORCID:0000-0002-7266-1487)
  • Received Date: 2021-11-15
  • Accepted Date: 2021-12-27
  • Published Date: 2022-06-20
    Abstract
  •   Objective  To investigate the association of energy metabolic markers with the risk of spontaneous bacterial peritonitis (SBP) in patients with decompensated hepatitis B virus-related liver cirrhosis (HBV-LC).  Methods  A retrospective analysis was performed for the clinical data of the patients with decompensated HBV-LC who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2019, and baseline clinical parameters and energy metabolic markers were compared between the patients with SBP and those without SBP within 2 weeks after admission. A multivariate logistic regression analysis was performed to investigate the risk factors for SBP. The t-test was used for comparison of normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between two groups; the Fisher's exact test was used for comparison of categorical data between two groups. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of the newly established logistic regression model, and with the corresponding point of Youden index as the cut-off value, the DeLong test was used to compare the area under the ROC curve (AUC).  Results  A total of 50 patients with decompensated HBV-LC were included, among whom 23 (46%) developed SBP within 2 weeks after admission and 27 (54%) had no SBP during hospitalization. Compared with the non-SBP patients, the SBP patients had significantly lower triglyceride, prealbumin, and prothrombin time activity (PTA) and significantly higher international normalization ratio, C-reactive protein (CRP), and Model for End-Stage Liver Disease score (all P < 0.05). Comparison of baseline energy metabolic markers showed that compared with the non-SBP patients, the SBP patients had significantly lower respiratory quotient (RQ) [0.79(0.76-0.86) vs 0.85(0.79-0.91), P=0.041] and carbohydrate oxidation (CHO) rate [20.50%(15.25%-41.05%) vs 41.6%(22.25%-68.05%), P=0.041]. The multivariate logistic regression analysis showed that PTA was an independent risk factor for SBP in the patients with decompensated HBV-LC during hospitalization (odd ratio=0.004, P=0.008), and the regression model established based on the variables including PTA, CRP, RQ, and CHO had an AUC of 85.0% and a cut-off value of 0.60 at the maximum Youden index, with a specificity of 85.19% and a sensitivity of 73.91%, suggesting that this model had a better discriminatory ability than CRP (AUC=74.5%, P=0.049) and procalcitonin (AUC=56.4%, P < 0.01).  Conclusion  There are significant reductions in the energy metabolic markers RQ and CHO in the patients with decompensated HBV-LC who develop SBP within a short term, and their combination with PTA, CRP, and CHO/RQ ratio can help clinicians identify the patients at a high risk of SBP in the early stage and enhance nutrition support for such patients.

     

    • FullText(HTML)
  • loading
    • References(27)
  • [1]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [2]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
    [3]
    MARCIANO S, DÍAZ JM, DIRCHWOLF M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies[J]. Hepat Med, 2019, 11: 13-22. DOI: 10.2147/HMER.S164250.
    [4]
    CHINNOCK B, AFARIAN H, MINNIGAN H, et al. Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis[J]. Ann Emerg Med, 2008, 52(3): 268-273. DOI: 10.1016/j.annemergmed.2008.02.016.
    [5]
    TANDON P, RAMAN M, MOURTZAKIS M, et al. A practical approach to nutritional screening and assessment in cirrhosis[J]. Hepatology, 2017, 65(3): 1044-1057. DOI: 10.1002/hep.29003.
    [6]
    LI YT, HUANG JR, PENG ML. Current status and prospects of spontaneous peritonitis in patients with cirrhosis[J]. Biomed Res Int, 2020, 2020: 3743962. DOI: 10.1155/2020/3743962.
    [7]
    MONTANO-LOZA AJ, MEZA-JUNCO J, PRADO CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis[J]. Clin Gastroenterol Hepatol, 2012, 10(2): 166-173, 173. e1. DOI: 10.1016/j.cgh.2011.08.028.
    [8]
    RODRIGUES SG, BRABANDT B, STIRNIMANN G, et al. Adipopenia correlates with higher portal pressure in patients with cirrhosis[J]. Liver Int, 2019, 39(9): 1672-1681. DOI: 10.1111/liv.14175.
    [9]
    Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.

    中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.
    [10]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
    [11]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [12]
    TERAKURA Y, SHIRAKI M, NISHIMURA K, et al. Indirect calorimetry and anthropometry to estimate energy metabolism in patients with liver cirrhosis[J]. J Nutr Sci Vitaminol (Tokyo), 2010, 56(6): 372-379. DOI: 10.3177/jnsv.56.372.
    [13]
    PENG S, PLANK LD, MCCALL JL, et al. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study[J]. Am J Clin Nutr, 2007, 85(5): 1257-1266. DOI: 10.1093/ajcn/85.5.1257.
    [14]
    PRIETO-FRÍAS C, CONCHILLO M, PAYERAS M, et al. Factors related to increased resting energy expenditure in men with liver cirrhosis[J]. Eur J Gastroenterol Hepatol, 2016, 28(2): 139-145. DOI: 10.1097/MEG.0000000000000516.
    [15]
    BELARMINO G, SINGER P, GONZALEZ MC, et al. Prognostic value of energy expenditure and respiratory quotient measuring in patients with liver cirrhosis[J]. Clin Nutr, 2019, 38(4): 1899-1904. DOI: 10.1016/j.clnu.2018.07.001.
    [16]
    de WAELE E, MALBRAIN M, SPAPEN H. Nutrition in Sepsis: A bench-to-bedside review[J]. Nutrients, 2020, 12(2): 395. DOI: 10.3390/nu12020395.
    [17]
    KAO CC, GUNTUPALLI KK, BANDI V, et al. Whole-body CO2 production as an index of the metabolic response to sepsis[J]. Shock, 2009, 32(1): 23-28. DOI: 10.1097/SHK.0b013e3181970f32.
    [18]
    GLASS C, HIPSKIND P, TSIEN C, et al. Sarcopenia and a physiologically low respiratory quotient in patients with cirrhosis: a prospective controlled study[J]. J Appl Physiol (1985), 2013, 114(5): 559-565. DOI: 10.1152/japplphysiol.01042.2012.
    [19]
    TAJIKA M, KATO M, MOHRI H, et al. Prognostic value of energy metabolism in patients with viral liver cirrhosis[J]. Nutrition, 2002, 18(3): 229-234. DOI: 10.1016/s0899-9007(01)00754-7.
    [20]
    NISHIKAWA H, ENOMOTO H, IWATA Y, et al. Prognostic significance of nonprotein respiratory quotient in patients with liver cirrhosis[J]. Medicine (Baltimore), 2017, 96(3): e5800. DOI: 10.1097/MD.0000000000005800.
    [21]
    LI A, MUKHOPADHYAY A. Correction to: Substrate utilization and energy expenditure pattern in sepsis by indirect calorimetry[J]. Crit Care, 2020, 24(1): 660. DOI: 10.1186/s13054-020-03391-7.
    [22]
    TANG L, YIN X. Diagnostic value of serum procalcitonin, C-reactive protein and neutrophil CD64 index in early diagnosis of neonatal infection with umbilical vein catheterization[J/CD]. Chin J Exp Clin Infect Dis(Electronic Edition), 2020, 14(4): 336-339. DOI: 10.3877/cma.j.issn.1674-1358.2020.04.013.

    唐磊, 尹旭. 血清降钙素原、C反应蛋白和中性粒细胞CD64指数对脐静脉置管新生儿感染早期诊断价值[J/CD]. 中华实验和临床感染病杂志(电子版), 2020, 14(4): 336-339. DOI: 10.3877/cma.j.issn.1674-1358.2020.04.013.
    [23]
    LI T, CHEN YY, SUN HS, et al. Application of hematology-related indexes in early diagnosis of bacterial infection of tumor patients in ICU[J]. J Jilin Univ(Med Edit), 2020, 46(4): 816-821. DOI: 10.13481/j.1671-587x.20200424.

    李铤, 陈媛媛, 孙洪帅, 等. 血液学相关指标在ICU肿瘤患者细菌感染早期诊断中的应用[J]. 吉林大学学报(医学版), 2020, 46(4): 816-821. DOI: 10.13481/j.1671-587x.20200424.
    [24]
    METWALLY K, FOUAD T, ASSEM M, et al. Predictors of spontaneous bacterial peritonitis in patients with cirrhotic ascites[J]. J Clin Transl Hepatol, 2018, 6(4): 372-376. DOI: 10.14218/JCTH.2018.00001.
    [25]
    ABDEL-RAZIK A, MOUSA N, ELHAMMADY D, et al. Ascitic fluid calprotectin and serum procalcitonin as accurate diagnostic markers for spontaneous bacterial peritonitis[J]. Gut Liver, 2016, 10(4): 624-631. DOI: 10.5009/gnl15120.
    [26]
    MIKUŁA T, SAPUŁA M, JABŁOŃSKA J, et al. Significance of heparin-binding protein and D-dimers in the early diagnosis of spontaneous bacterial peritonitis[J]. Mediators Inflamm, 2018, 2018: 1969108. DOI: 10.1155/2018/1969108.
    [27]
    SHEN HX, LOU XP, CHANG XW, et al. Risk factors for spontaneous bacterial peritonitis in cirrhotic patients: A meta analysis[J]. World Chin J Dig, 2016, 24(12): 1903-1909. DOI: 10.11569/wcjd.v24.i12.1903.

    申红霞, 娄小平, 苌新伟, 等. 肝硬化患者自发性细菌性腹膜炎危险因素的Meta分析[J]. 世界华人消化杂志, 2016, 24(12): 1903-1909. DOI: 10.11569/wcjd.v24.i12.1903.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(4)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (364) PDF downloads(44) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return