Mayo Clinic Proceedings Home

Model for End-Stage Liver Disease Score Predicts Development of First Episode of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis



      To examine whether baseline model for end-stage liver disease (MELD) score in patients with cirrhosis and ascites predicts the future development of first spontaneous bacterial peritonitis (SBP) episode.


      A retrospective case-control study was performed at three academic centers to select patients admitted with first SBP episode (cases) and those with ascites admitted for decompensation without SBP (controls). Medical records from these centers were reviewed between January 1, 2008, and December 31, 2013. Cases and controls were matched (1:2) for age, sex, and race. Conditional logistic recession models were built to determine whether baseline MELD score (within a month before hospitalization) predicts first SBP episode.


      Of 697 patients (308, 230, and 159 from centers A, B, and C, respectively), cases and controls were matched in 94%, 89%, and 100% at three respective centers. In the pooled sample, probability of SBP was 11%, 31%, 71%, and 93% at baseline MELD scores less than or equal to 10, from 11 to 20, from 21 to 30, and greater than 30, respectively. Compared with MELD score less than or equal to 10, patients with MELD scores from 11 to 20, 21 to 30, and greater than 30 had six- (3- to 11-), 29- (12- to 69-), and 115- (22- to 598-) folds (95% CI) risk of SBP, respectively. Based on different MELD score cutoff points, MELD score greater than 17 was most accurate in predicting SBP occurrence. Analyzing 315 patients (152 cases) with available data on ascitic fluid protein level controlling for age, sex, and center, MELD score but not ascitic fluid protein associated with first SBP episode with respective odds ratios of 1.20 (1.14 to 1.26) and 0.88 (0.70 to 1.11).


      Baseline MELD score predicts first SBP episode in patients with cirrhosis and ascites.

      Abbreviations and Acronyms:

      MELD (model for end-stage liver disease), OR (odds ratio), PPI (proton pump inhibitor), SBP (spontaneous bacterial peritonitis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kim W.R.
        • Brown Jr., R.S.
        • Terrault N.A.
        • El-Serag H.
        Burden of liver disease in the United States: summary of a workshop.
        Hepatology. 2002; 36: 227-242
        • Asrani S.K.
        • Larson J.J.
        • Yawn B.
        • Therneau T.M.
        • Kim W.R.
        Underestimation of liver-related mortality in the United States.
        Gastroenterology. 2013; 145 (e371-e372): 375-382
        • Bonnel A.R.
        • Bunchorntavakul C.
        • Reddy K.R.
        Immune dysfunction and infections in patients with cirrhosis.
        Clin Gastroenterol Hepatol. 2011; 9: 727-738
        • Arvaniti V.
        • D'Amico G.
        • Fede G.
        • et al.
        Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis.
        Gastroenterology. 2010; 139 (1256.e1241-e1245): 1246-1256
        • Singal A.K.
        • Salameh H.
        • Kamath P.S.
        Prevalence and in-hospital mortality trends of infections among patients with cirrhosis: a nationwide study of hospitalised patients in the United States.
        Aliment Pharmacol Ther. 2014; 40: 105-112
        • Bajaj J.S.
        • O'Leary J.G.
        • Reddy K.R.
        • et al.
        Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American consortium for the study of end-stage liver disease (NACSELD) experience.
        Hepatology. 2012; 56: 2328-2335
        • Thuluvath P.J.
        • Morss S.
        • Thompson R.
        Spontaneous bacterial peritonitis—in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998.
        Am J Gastroenterol. 2001; 96: 1232-1236
        • Runyon B.A.
        • Practice Guidelines Committee AASLD
        Management of adult patients with ascites due to cirrhosis.
        Hepatology. 2004; 39: 841-856
        • Saab S.
        • Hernandez J.C.
        • Chi A.C.
        • Tong M.J.
        Oral antibiotic prophylaxis reduces spontaneous bacterial peritonitis occurrence and improves short-term survival in cirrhosis: a meta-analysis.
        Am J Gastroenterol. 2009; 104 (quiz 1002): 993-1001
        • Fernandez J.
        • Navasa M.
        • Planas R.
        • et al.
        Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis.
        Gastroenterology. 2007; 133: 818-824
        • Terg R.
        • Fassio E.
        • Guevara M.
        • et al.
        Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study.
        J Hepatol. 2008; 48: 774-779
        • Grange J.D.
        • Roulot D.
        • Pelletier G.
        • et al.
        Norfloxacin primary prophylaxis of bacterial infections in cirrhotic patients with ascites: a double-blind randomized trial.
        J Hepatol. 1998; 29: 430-436
        • Novella M.
        • Sola R.
        • Soriano G.
        • et al.
        Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin.
        Hepatology. 1997; 25: 532-536
        • Loomba R.
        • Wesley R.
        • Bain A.
        • Csako G.
        • Pucino F.
        Role of fluoroquinolones in the primary prophylaxis of spontaneous bacterial peritonitis: meta-analysis.
        Clin Gastroenterol Hepatol. 2009; 7: 487-493
        • Kamath P.S.
        • Wiesner R.H.
        • Malinchoc M.
        • et al.
        A model to predict survival in patients with end-stage liver disease.
        Hepatology. 2001; 33: 464-470
        • Bajaj J.S.
        • Zadvornova Y.
        • Heuman D.M.
        • et al.
        Association of proton pump inhibitor therapy with spontaneous bacterial peritonitis in cirrhotic patients with ascites.
        Am J Gastroenterol. 2009; 104: 1130-1134
        • Bal C.K.
        • Daman R.
        • Bhatia V.
        Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis.
        World J Hepatol. 2016; 8: 566-572
        • Wehmeyer M.H.
        • Krohm S.
        • Kastein F.
        • Lohse A.W.
        • Luth S.
        Prediction of spontaneous bacterial peritonitis in cirrhotic ascites by a simple scoring system.
        Scand J Gastroenterol. 2014; 49: 595-603
        • Fernandez J.
        • Acevedo J.
        • Castro M.
        • et al.
        Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study.
        Hepatology. 2012; 55: 1551-1561
        • O'Leary J.G.
        • Reddy K.R.
        • Wong F.
        • et al.
        Long-term use of antibiotics and proton pump inhibitors predict development of infections in patients with cirrhosis.
        Clin Gastroenterol Hepatol. 2015; 13 (e751-e752): 753-759
        • Terg R.
        • Casciato P.
        • Garbe C.
        • et al.
        Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study.
        J Hepatol. 2015; 62: 1056-1060
        • Karvellas C.J.
        • Abraldes J.G.
        • Arabi Y.M.
        • Kumar A.
        • Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group
        Appropriate and timely antimicrobial therapy in cirrhotic patients with spontaneous bacterial peritonitis-associated septic shock: a retrospective cohort study.
        Aliment Pharmacol Ther. 2015; 41: 747-757
        • Wade J.J.
        • Rolando N.
        • Hayllar K.
        • Philpott-Howard J.
        • Casewell M.W.
        • Williams R.
        Bacterial and fungal infections after liver transplantation: an analysis of 284 patients.
        Hepatology. 1995; 21: 1328-1336
        • Mathurin P.
        • Moreno C.
        • Samuel D.
        • et al.
        Early liver transplantation for severe alcoholic hepatitis.
        N Engl J Med. 2011; 365: 1790-1800