Prevalence and prognostic value of hepatocellular carcinoma in cirrhotic patients presenting with spontaneous bacterial peritonitis

Background/Aims: This study examined the prognostic power of hepatocellular carcinoma in patients presenting an episode of spontaneous bacterial perit onitis treated with 3rd generation cephalosporins or quinolones, and subseq uent prophylaxis with norfloxacin until death or transplantation. Methods: The study comprises the prospective evaluation of 168 consecutive cirrhosis patients presenting an episode of spontaneous bacterial peritonit is, Results: Hepatocellular carcinoma was diagnosed in 35 out of the 168 (20%) patients included in the study (10 single; 25 advanced tumors), Renal impai rment developed in 82 patients, Resolution of infection was achieved in 90% of the cases, the hospital survival being 70%, Renal impairment, advanced tumor stage, albumin, and GGT showed independent prognostic value for hospi tal mortality, At the end of follow-up 101 patients had died, the 1- and 2- year survival being 36% and 31%, respectively, Four variables independently predicted survival: advanced tumor (OR: 3.9; p=0.00001), renal impairment (OR: 2.1; p=0.00001), bilirubin (OR: 1.6; p=0.02) and creatinine (OR: 1.3; p=0.03), Advanced tumor retained independent predictability in patients sur viving hospitalization (OR: 7.5; p=0.0001), the 6-month survival being sign ificantly lower in patients with advanced tumor (12% vs 57%, p<0.00001). Conclusion: The prevalence of hepatocellular carcinoma in cirrhotic patient s with spontaneous bacterial peritonitis is high, and its presence should b e actively sought. Advanced tumor impairs both hospital and long-term survi val, and should be considered in the design of future trials.