Background and Aim: It has been suggested that propranolol may have a
protective effect on the development of spontaneous bacterial
peritonitis by increasing the motility of the bowel and lowering the
pressure of the portal vein. The aim of this study is to evaluate the
association between the use of propranolol and development of
spontaneous bacterial peritonitis in patients with cirrhosis and
ascites.
Methods: We retrospectively evaluated 134 patients with cirrhosis and
ascites admitted consecutively for a period of 2 years. Diagnosis of
spontaneous bacterial peritonitis was based on an ascitic fluid
neutrophilic count of > 250/mm(3) and/or a positive culture without
evidence of secondary peritonitis.
Results: Spontaneous bacterial peritonitis was diagnosed in 39 of 134
(29%) patients and 12 of 39 (31%) patients died in hospital compared
to only 4% (four of 95) of those without spontaneous bacterial
peritonitis (P < 0.001). At admission, patients with spontaneous
bacterial peritonitis, as compared to those without, had significantly
more encephalopathy (28 vs 11%, P = 0.02) or fever (18 vs 4%, P =
0.01) and less frequently tense ascites (33 vs 57%, P = 0.02).
Spontaneous bacterial peritonitis was diagnosed in six of 33 (18%)
patients who did and in 33 of 101 (33%) who did not receive propranolol
therapy (OR = 0.46, 95% CI: 0.17-1.22, P = 0.17).
Conclusion: Our data indicate that spontaneous bacterial peritonitis
significantly increases mortality in patients with cirrhosis.
Propranolol therapy was not found to be associated with a significantly
lower risk for spontaneous bacterial peritonitis, but a Type II
statistical error cannot be definitely excluded. The potential
protective effect of propranolol on the incidence of spontaneous
bacterial peritonitis might deserve evaluation in properly designed
prospective studies. (C) 2005 Blackwell Publishing Asia Pty Ltd
