Duggal S, Kalas M, Jurado A, Mendoza E, Mahapatra S, Garrison K, Zuckerman MJ, Robles A. Factors associated with refractory ascites and spontaneous bacterial peritonitis in a predominantly Hispanic population: A retrospective analysis. World J Gastrointest Pathophysiol 2025; 16(3): 108842 [DOI: 10.4291/wjgp.v16.i3.108842]
Corresponding Author of This Article
Shivangini Duggal, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX 79905, United States. sduggal@ttuhsc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pathophysiol. Sep 22, 2025; 16(3): 108842 Published online Sep 22, 2025. doi: 10.4291/wjgp.v16.i3.108842
Factors associated with refractory ascites and spontaneous bacterial peritonitis in a predominantly Hispanic population: A retrospective analysis
Shivangini Duggal, Mutaz Kalas, Alan Jurado, Edwin Mendoza, Swati Mahapatra, Keith Garrison, Marc J Zuckerman, Alejandro Robles
Shivangini Duggal, Mutaz Kalas, Alan Jurado, Edwin Mendoza, Swati Mahapatra, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
Keith Garrison, Marc J Zuckerman, Alejandro Robles, Division of Gastroenterology, Texas Tech University Health Science Center, El Paso, TX 79905, United States
Author contributions: Duggal S designed the research; Duggal S, Kalas M, Jurado A, Mendoza E and Garrison K performed the research; Duggal S did the data analysis; Duggal S, Kalas M, Jurado A, Mendoza E and Garrison K wrote the original draft; Zuckerman M and Robles A did the review and editing; All authors discussed the findings described in the case and approved the final manuscript; Article guarantor is Robles A.
Institutional review board statement: The participants of study were 179 patients diagnosed with ascites (refractory or spontaneous bacterial peritonitis) and admitted to the University Medical Center, El Paso and Texas Tech University Health Sciences Center, El Paso between July 1, 2013 to December 31, 2023. The research was approved by the Ethics Committee of Texas Tech University Health Sciences Center El Paso (#E24123).
Informed consent statement: Exemption from informed consent was obtained via the Institutional Review Board Committee at Texas Tech University Health Sciences Center El Paso, TX, United States.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: None.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shivangini Duggal, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX 79905, United States. sduggal@ttuhsc.edu
Received: April 24, 2025 Revised: May 27, 2025 Accepted: July 15, 2025 Published online: September 22, 2025 Processing time: 148 Days and 11.4 Hours
Abstract
BACKGROUND
Refractory ascites (RA) and spontaneous bacterial peritonitis (SBP) are severe complications of decompensated cirrhosis, contributing to high morbidity and mortality. RA develops when ascites persists despite maximum diuretic therapy, while SBP arises from bacterial translocation and immune dysfunction in cirrhotic patients with ascites. Identifying key risk factors associated with these conditions is crucial for early intervention and improved patient outcomes.
AIM
To assess clinical and biochemical predictors of RA and SBP in a cohort of hospitalized patients with cirrhotic ascites.
METHODS
A retrospective chart review was conducted on patients with cirrhotic ascites diagnosed with RA or SBP at University Medical Center, El Paso, from July 1, 2013 to December 31, 2023. Patient demographics, clinical history, laboratory parameters, ascitic fluid analysis, and cirrhosis severity scores [Model for End-Stage Liver Disease-Sodium (MELD-Na) and Child-Pugh] were recorded. Statistical analyses, including multivariate logistic regression, were performed to identify independent predictors of RA and SBP, with a significance threshold of P < 0.05.
RESULTS
A total of 179 patients were included, with a mean age of 59.08 ± 13.04 years, predominantly male (55.9%) and Hispanic (98.3%). The most common etiology of cirrhosis was alcohol-related liver disease (45.3%), and most patients had Grade III ascites (95.5%). Among them, 115 (64.2%) had RA, and 57 (31.8%) had SBP. RA was significantly associated with abnormal serum potassium levels [odds ratio (OR) = 2.27, 95%CI: 1.06–4.84, P = 0.034], while SBP was independently predicted by gastrointestinal bleeding (OR = 2.59, 95%CI: 1.18–5.64, P = 0.017) and thrombocytopenia (platelet count < 50000; OR = 3.27, 95%CI: 1.08–9.88, P = 0.035).
CONCLUSION
RA and SBP are major complications of cirrhosis, with electrolyte imbalances and coagulopathy playing key roles in their development. Our study confirms that abnormal potassium levels significantly predict RA, while gastrointestinal bleeding and thrombocytopenia are strong predictors of SBP. These findings emphasize the need for early risk stratification and targeted management strategies to improve outcomes in high-risk cirrhotic patients, particularly in minority populations with limited healthcare access. Further prospective studies are warranted to validate these results and explore potential interventions to reduce RA and SBP incidence.
Core Tip: In this retrospective study of 179 cirrhotic patients with ascites, we identified key clinical predictors for refractory ascites (RA) and spontaneous bacterial peritonitis (SBP) in a predominantly Hispanic population. Abnormal serum potassium levels independently predicted RA, while gastrointestinal bleeding and thrombocytopenia (platelet count < 50000/µL) were significant predictors of SBP. These findings emphasize the critical role of electrolyte imbalance and coagulopathy in cirrhosis-related complications and highlight the importance of early risk stratification in vulnerable populations with limited healthcare access.
