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Am Fam Physician. 2022;106(4):online

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: 288 patients with spontaneous bacterial peritonitis (SBP) from four randomized controlled trials

Efficacy End Points: Renal impairment and mortality

Harm End Points: Not reported

GreenBenefits greater than harms
YellowUnclear benefits
RedNo benefits
BlackHarms greater than benefits

Narrative: SBP is a potentially deadly complication of ascites in patients with cirrhosis, with mortality approaching 30%.1,2 Patients with cirrhosis and ascites are immunocompromised, and SBP can cause the release of proinflammatory mediators such as cytokines and nitric oxide within the bloodstream and ascitic fluid, which can lead to hypotension. Cirrhosis and ascites also result in splanchnic vasodilation, which can decrease the effective arterial volume and activate the sympathetic nervous system and renin-angiotensin-aldosterone system.2,3 This can contribute to renal impairment, which occurs in 30% to 40% of patients with SBP and is the strongest predictor of mortality in these patients.27

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This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

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