Factors associated with refractory ascites and spontaneous bacterial peritonitis in a predominantly Hispanic population: A retrospective analysis

doi:10.4291/wjgp.v16.i3.108842

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World Journal of Gastrointestinal Pathophysiology

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Retrospective Study

World J Gastrointest Pathophysiol. Sep 22, 2025; 16(3): 108842
Published online Sep 22, 2025. doi: 10.4291/wjgp.v16.i3.108842

Table 1 Descriptive characteristics of the whole cohort with 179 patients, n (%)

Variables		Total (n = 179)
	Mean age	59.08 ± 13.04
Gender	Male	100 (55.9)
	Female	79 (44.1)
Ethnicity	Hispanic or Latino	176 (98.3)
	Caucasian	2 (1.1)
	African American	1 (0.6)
Etiology of liver disease	Hepatitis (A, B, C, D)	23 (12.8)
	Congenital liver disease	3 (1.7)
	MASH	11 (6.1)
	Alcoholic liver disease	81 (45.3)
	Autoimmune hepatitis	26 (14.5)
	Others	26 (14.5)
	NA	9 (5.0)
Severity of ascites	Grade I	3 (1.7)
	Grade II	5 (2.8)
	Grade III	171 (95.5)
HE	None	119 (66.5)
	Grade I	4 (2.2)
	Grade II	40 (22.3)
	Grade III	13 (7.3)
	Grade IV	2 (1.1)
GI bleed		76 (42.5)
Serum BUN	< 25 mg/dL	71 (39.7)
	25-35 mg/dL	34 (19.0)
	> 35 mg/dL	74 (41.3)
Mean creatinine		2.37 ± 2.39
Platelet count	1.5-4.5 × 10³	55 (30.7)
	1-1.49 × 10³	47 (26.3)
	50000-99999	57 (31.8)
	< 500000	20 (11.2)
INR	< 1.7	77 (43.0)
	1.7-2.3	56 (31.3)
	> 2.3	46 (25.7)
Bilirubin	< 2 mg/dL	58 (32.4)
	2-3 mg/dL	38 (21.2)
	> 3 mg/dL	83 (46.4)
Albumin	> 3.5 g/dL	10 (5.6)
	2.8-3.5 g/dL	82 (45.8)
	< 2.8 g/dL	87 (48.6)
Sodium	136-145 mEq/L	38 (21.2)
	126-135 mEq/L	111 (62.0)
	< 125 mEq/L	27 (15.1)
	> 135 mEq/L	3 (1.7)
Serum potassium	3.5-5.5 mEq/L	83 (46.4)
	< 3.5 mEq/L	62 (34.6)
	> 5.5 mEq/L	34 (19)
Child Pugh score	Class A	8 (4.5)
	Class B	59 (33.0)
	Class C	112 (62.6)
MELD-Na score	6-15	26 (14.5)
	16-25	73 (40.8)
	26-35	64 (35.8)
	> 35	16 (8.9)
Ascitic fluid protein	Low	109 (60.9)
	High	70 (39.1)
Liver transplant	Yes	39 (21.79)
	No	140 (78.21)
Death	Yes	87 (48.60)
	No	92 (51.40)

MASH: Metabolic Dysfunction-Associated Steatohepatitis; HE: Hepatic encephalopathy; BUN: Blood urea nitrogen; INR: International normalized ratio; MELD-Na: Model for End-Stage Liver Disease-Sodium; NA: Not available.

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Table 2 Factors associated with mortality

Variables		Mortality		P value
Variables		No (n = 92)	Yes (n = 87)	P value
	Mean age	59.47 ± 13.56	58.67 ± 12.54	0.68
Gender	Male	49	51	0.47
Gender	Female	43	36	0.47
Ethnicity	Hispanic or Latino	90	86	0.22
	Caucasian	2	0
	African American	0	1
Etiology of liver disease	Hepatitis (A, B, C, D)	11	12	0.61
	Congenital liver disease	0	3
	MASH	5	6
	Alcoholic liver disease	44	37
	Autoimmune hepatitis	15	11
	Others	12	14
	NA	5	4
Severity of ascites	Grade I	2	1	0.82
	Grade II	3	2
	Grade III	87	81
HE	None	60	59	0.43
	Grade I	1	3
	Grade II	23	17
	Grade III	6	7
	Grade IV	2	0
GI bleed		39	37	0.98
Serum BUN	< 25 mg/dL	36	35	0.78
	25-35 mg/dL	16	18
	> 35 mg/dL	40	34
Mean creatinine		2.33 ± 2.31	2.41 ± 2.48
CLIF-ACLF		49.57 ± 5.73	63.77 ± 6.36	< 0.001
Platelet count	1.5-4.5 × 10³	30	25	0.87
	1-1.49 × 10³	23	24
	50000-99999	30	27
	< 500000	9	11
INR	< 1.7	42	35	0.64
	1.7-2.3	26	30
	> 2.3	24	22
Bilirubin	< 2 mg/dL	25	33	0.30
	2-3 mg/dL	21	17
	> 3 mg/dL	46	37
Albumin	> 3.5 g/dL	4	6	0.30
	2.8-3.5 g/dL	40	42
	< 2.8 g/dL	48	39
Sodium	136-145 mEq/L	17	21	0.70
	126-135 mEq/L	59	52
	< 125 mEq/L	15	12
	> 135 mEq/L	1	2
Serum potassium	3.5-5.5 mEq/L	42	41	0.93
	< 3.5 mEq/L	33	29
	> 5.5 mEq/L	17	17
Child Pugh score	Class A	5	3	0.12
	Class B	24	35
	Class C	63	49
MELD-Na score	6-15	11	15	0.02
	16-25	34	39
	26-35	42	22
	> 35	5	11
Ascitic fluid protein	Low	55	54	0.75
Ascitic fluid protein	High	37	33	0.75

NA: Not available; MASH: Metabolic Dysfunction-Associated Steatohepatitis; HE: Hepatic encephalopathy; GI: Gastrointestinal; BUN: Blood urea nitroge; INR: International normalized ratio; MELD-Na: Model for End-Stage Liver Disease-Sodium.

Full Size Table

Table 3 Factors associated with refractory ascites, n (%)

Variables		Refractory ascites		P value
Variables		Yes (n = 115)	No (n = 64)	P value
	Mean age	56.96 ± 12.40	62.89 ± 13.39	< 0.01
Gender	Male	65 (56.5)	35 (54.7)	0.81
Gender	Female	50 (43.5)	29 (45.3)	0.81
Ethnicity	Hispanic or Latino	114 (99.1)	62 (96.9)	0.36
	Caucasian	1 (0.9)	1 (1.6)
	African American	0 (0.0)	1 (1.6)
Etiology of liver disease	Hepatitis (A, B, C, D)	10 (8.7)	13 (20.3)	0.09
	Congenital liver disease	2 (1.7)	1 (1.6)
	MASH	7 (6.1)	4 (6.3)
	Alcoholic liver disease	56 (48.7)	25 (39.1)
	Autoimmune hepatitis	20 (17.4)	6 (9.4)
	Others	17 (14.8)	9 (14.1)
	NA	3 (2.6)	6 (9.4)
Severity of ascites	Grade I	1 (0.9)	2 (3.1)	0.26
	Grade II	2 (1.7)	3 (4.7)
	Grade III	112 (97.4)	59 (92.2)
HE	None	76 (66.1)	43 (67.2)	0.67
	Grade I	2 (1.7)	2 (3.1)
	Grade II	29 (25.2)	11 (17.2)
	Grade III	7 (6.1)	6 (9.4)
	Grade IV	1 (0.9)	1 (1.6)
GI bleed		56 (48.7)	20 (31.3)	0.02
Serum BUN	< 25 mg/dL	38 (33.0)	33 (51.6)	0.04
	25-35 mg/dL	23 (20.0)	11 (17.2)
	> 35 mg/dL	54 (47.0)	20 (31.3)
Mean creatinine		2.79 ± 2.74	1.61 ± 1.29	< 0.01
Platelet count	1.5-4.5 × 10³	38 (33.0)	17 (26.6)	0.61
	1-1.49 × 10³	27 (23.5)	20 (31.3)
	50000-99999	38 (33.0)	19 (29.7)
	< 500000	12 (10.4)	8 (12.5)
INR	< 1.7	42 (36.5)	35 (54.7)	< 0.01
	1.7-2.3	35 (30.4)	21 (32.8)
	> 2.3	38 (33.0)	8 (12.5)
Bilirubin	< 2 mg/dL	34 (29.6)	24 (37.5)	0.10
	2-3 mg/dL	21 (18.3)	17 (26.6)
	> 3 mg/dL	60 (52.2)	23 (35.9)
Albumin	> 3.5 g/dL	5 (4.3)	5 (7.8)	0.56
	2.8-3.5 g/dL	52 (45.2)	30 (46.9)
	< 2.8 g/dL	58 (50.4)	29 (45.3)
Sodium	136-145 mEq/L	19 (16.5)	19 (29.7)	0.13
	126-135 mEq/L	73 (63.5)	38 (59.4)
	< 125 mEq/L	21 (18.3)	6 (9.4)
	> 135 mEq/L	2 (1.7)	1 (1.6)
Serum potassium	3.5-5.5 mEq/L	42 (36.5)	41 (64.1)	< 0.001
	< 3.5 mEq/L	45 (39.1)	17 (26.6)
	> 5.5 mEq/L	28 (24.3)	6 (9.4)
Child Pugh score	Class A	4 (3.5)	4 (6.3)	0.03
	Class B	31 (27.0)	28 (43.8)
	Class C	80 (69.6)	32 (50.0)
MELD-Na score	6-15	14 (12.2)	12 (18.8)	0.02
	16-25	40 (34.8)	33 (51.6)
	26-35	48 (41.7)	16 (25.0)
	> 35	13 (11.3)	3 (4.7)
Ascitic fluid protein	Low	69 (60.0)	40 (62.5)	0.87
Ascitic fluid protein	High	46 (40.0)	24 (37.5)	0.87
CLIF-ACLF		56.33 ± 9.49	56.53 ± 9.29	0.89

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Table 4 After doing multivariate logistic regression analysis, serum abnormal potassium level [adjusted odds ratio 2.27 (95%CI: 1.06-4.84)], was found to be associated with development of refractory ascites

	P values	Odds ratio	95%CI for odds ratio
	P values	Odds ratio	Lower	Upper
GI bleed	0.392	1.394	0.651	2.988
Serum BUN > 25	0.506	1.342	0.564	3.191
Creatinine level	0.295	1.166	0.875	1.556
INR > 1.7	0.429	1.388	0.616	3.131
Serum potassium abnormal	0.034	2.270	1.064	4.845
MELD-Na score	0.956	1.016	0.575	1.797

BUN: Blood urea nitroge; INR: International normalized ratio; MELD-Na: Model for End-Stage Liver Disease-Sodium; GI: Gastrointestinal.

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Table 5 Factors associated with development of spontaneous bacterial peritonitis, n (%)

Variables		Yes (n = 57)	No (n = 122)	P value
	Mean age	59.79 ± 10.53	58.75 ± 14.09	0.61
Gender	Male	28 (49.1)	72 (59.0)	0.21
Gender	Female	29 (50.9)	50 (41.0)	0.21
Ethnicity	Hispanic or Latino	56 (98.2)	120 (98.4)	0.68
	Caucasian	1 (1.8)	1 (0.8)
	African American	0 (0.0)	1 (0.8)
	Use of alcohol	32 (56.1)	68 (55.7)	0.96
Etiology of liver disease	Hepatitis (A, B, C, D)	7 (12.3)	16 (13.1)	0.77
	Congenital liver disease	0 (0.0)	3 (2.5)
	NASH	4 (7.0)	7 (5.7)
	ALD	25 (43.9)	56 (45.9)
	Autoimmune hepatitis	8 (14.0)	18 (14.8)
	Others	11 (19.3)	15 (12.3)
	NA	2 (3.5)	7 (5.7)
Severity of ascites	Grade I	0 (0.0)	3 (2.5)	0.45
	Grade II	2 (3.5)	3 (2.5)
	Grade III	55 (96.5)	116 (95.1)
HE	None	38 (66.7)	81 (66.4)	0.64
	Grade I	0 (0.0)	4 (3.3)
	Grade II	12 (21.1)	28 (23.0)
	Grade III	5 (8.8)	8 (6.6)
	Grade IV	1 (1.8)	1 (0.8)
GI bleed		33 (57.9)	43 (35.2)	< 0.01
Serum BUN	< 25 mg/dL	18 (31.6)	53 (43.4)	0.05
	25-35 mg/dL	8 (14.0)	26 (21.3)
	> 35 mg/dL	31 (54.4)	43 (35.2)
Mean creatinine		2.81 ± 1.44	2.16 ± 2.34	0.09
Platelet count	1.5-4.5 × 10³/μL	17 (29.8)	38 (31.1)	0.02
	1-1.49 × 10³/μL	15 (26.3)	32 (26.2)
	50000-99999/μL	13 (22.8)	44 (36.1)
	< 50000/μL	12 (21.1)	8 (6.6)
INR	< 1.7	25 (43.9)	52 (42.6)	0.14
	1.7-2.3	13 (22.8)	43 (35.2)
	> 2.3	19 (33.3)	27 (22.1)
Bilirubin	< 2 mg/dL	17 (29.8)	41 (33.6)	0.14
	2-3 mg/dL	8 (14.0)	30 (24.6)
	> 3 mg/dL	32 (56.1)	51 (41.8)
Albumin	> 3.5 g/dL	3 (5.3)	7 (5.7)	0.37
	2.8-3.5 g/dL	22 (38.6)	60 (49.2)
	< 2.8 g/dL	32 (56.1)	55 (45.1)
Sodium	136-145 mEq/L	10 (17.5)	28 (23.0)	0.40
	126-135 mEq/L	36 (63.2)	75 (61.5)
	< 125 mEq/L	11 (19.3)	16 (13.1)
	> 135 mEq/L	0 (0.0)	3 (2.5)
Serum potassium	3.5-5.5 mEq/L	26 (45.6)	57 (46.7)	0.18
	< 3.5 mEq/L	16 (28.1)	46 (37.7)
	> 5.5 mEq/L	15 (26.3)	19 (15.6)
Child Pugh score	Class A	3 (5.3)	5 (4.1)	0.14
	Class B	13 (22.8)	46 (37.7)
	Class C	41 (71.9)	71 (58.2)
MELD-Na score	6-15	10 (17.5)	16 (13.1)	0.001
	16-25	11 (19.3)	62 (50.8)
	26-35	30 (52.6)	34 (27.9)
	> 35	6 (10.5)	10 (8.2)
Ascitic fluid protein	Low	36 (63.2)	73 (59.8)	0.795
Ascitic fluid protein	High	21 (36.8)	49 (40.2)	0.795
CLIF-ACLF		56.13 ± 9.04	57.08 ± 9.86	0.51

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Table 6 After doing multivariate logistic regression analysis, presence of gastrointestinal bleed [adjusted odds ratio 2.59 (95%CI: 1.18-5.64)], platelet count < 50000 [adjusted odds ratio 3.27 (95%CI: 1.08-9.88)]

	P values	Odds ratio	95%CI for odds ratio
	P values	Odds ratio	Lower	Upper
GI bleed	0.017	2.591	1.188	5.648
Serum BUN > 35	0.425	1.522	0.542	4.271
Platelet count < 50000	0.035	3.275	1.085	9.883
MELD-Na score > 25	0.289	1.612	0.667	3.899
Creatinine absolute	0.495	0.931	0.758	1.143

BUN: Blood urea nitroge; MELD-Na: Model for End-Stage Liver Disease-Sodium; GI: Gastrointestinal.

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Citation: 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
URL: https://www.wjgnet.com/2150-5330/full/v16/i3/108842.htm
DOI: https://dx.doi.org/10.4291/wjgp.v16.i3.108842