Inpatient Outcomes of Spontaneous Bacterial Peritonitis in Patients with Sickle Cell Disease

Introduction: Spontaneous bacterial peritonitis (SBP) is a severe complication that can occur in patients with sickle cell disease (SCD), particularly those experiencing splenic dysfunction and portal hypertension. This condition is characterized by infection of the peritoneal cavity without an obvious source, often leading to significant morbidity and mortality. Using the nationwide database, this study evaluated inpatient outcomes associated with SBP in SCD patients.

Methods: The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) was used to identify adult patients with SCD during 2016 - 2020 using ICD-10-CM codes (D57). ICD-10-CM codes were used to identify patients who had SBP. The primary outcomes were in-hospital mortality, length of stay (LOS), and hospital costs. The secondary outcomes included renal cancer, pancreatic cancer, acute liver failure, liver cirrhosis, hepatic steatosis, and hepatitis B and C. The association between spontaneous bacterial peritonitis and SCD was evaluated using survey-based multivariate logistic regression models for in-hospital mortality and secondary outcomes, Poisson regression for LOS, and a generalized linear model with gamma distribution and log link for hospitalization cost. Models were adjusted for age, sex, race and ethnicity, primary payer, Charlson comorbidity index, hospital bed size, hospital region, and hospital teaching status.

Results: A total of 899,610 SCD patients were identified as required hospitalization between 2016 and 2020 in the United States, and 320 (0.04%) of them had SBP. Inpatient mortality and length of stay were significantly higher in SCD patients with SBP compared to those without SBP (inpatient mortality: 11% vs 0.6%, adjusted OR: 5.27, 95% CI: 2.30 - 12.00, P < 0.001; length of stay: 11.5 vs 5.1 days, p = 0.033). SCD patients with SBP had an increased cost of hospitalization ($36,769 ± 12,018 vs $11,818 ± 105, P < 0.045). SCD patients with SBP had increased odds of having liver cirrhosis and acute liver failure (55% vs 1.1%, 17% vs 0.3%, respectively, p < 0.001).

Conclusion: This analysis shows thatwhile the incidence of SBP in this population is low, it is associated with significantly higher inpatient mortality, prolonged hospital stays, increased hospitalization costs, and elevated rates of hepatic complications. Further research is essential to explore the gastrointestinal complications arising from hepatic and splenic dysfunction in this cohort and identify any preventative strategies to mitigate these risks.

Winer:MDX: Consultancy.