The most common complication of liver cirrhosis is ascites, with other hepatic complications being hepatic encephalopathy and variceal haemorrhage (Runyon et al., 2009; Runyon, 2012). The development of ascites is associated with a poor prognosis, with 5-year survival of around 40% (Bernardi et al., 2014).
Patients with cirrhosis and ascites are at high risk for other complications of liver disease, including refractory ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and hyponatraemia (European Association for the Study of the Liver, 2010).
The figure below summarises the main pathophysiological events and complications of cirrhosis (Bernardi et al., 2014).
A study of 309 patients with cirrhosis found that 75.4% (n=233) had evidence of ascites. A bacterial infection was diagnosed in 44.6% of patients with cirrhosis and ascites (n=104), with the bacterial infection associated with renal failure in around a third of patients (33.6%; n=35) (Fasolato et al., 2007). In cirrhotic patients with spontaneous bacterial peritonitis renal failure is a risk factor for mortality (Navasa et al., 1998).
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