{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T07:45:36Z","timestamp":1782632736023,"version":"3.54.5"},"reference-count":53,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009367","name":"Mansoura University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gut Pathog"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aim<\/jats:title>\n                    <jats:p>Recurrent spontaneous bacterial peritonitis (SBP) is a major concern for cirrhotic patients with ascites. This study seeks to identify predictors of recurrent SBP using clinical factors, inflammatory markers, and machine learning models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>The study involved 347 patients with cirrhotic ascites and SBP. Receiver Operating Characteristic (ROC) curve analysis assessed the predictive ability of biomarkers. A composite score was created to evaluate the risk stratification model. Different machine learning models were compared for predictive accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-three patients (23.9%) experienced recurrent SBP. Independent predictors of recurrence in multivariable analysis included acute kidney injury (AKI), elevated C-reactive protein (CRP) levels, higher serum bilirubin levels, a higher model for end-stage liver disease (MELD) score, proton-pump inhibitor (PPI) use, and lack of \u03b2-blocker use. A composite 10-point score (including AKI, CRP\u2009&gt;\u200950\u00a0mg\/L, low albumin levels\u2009&lt;\u20092.5\u00a0g\/dL, ascitic protein\u2009&lt;\u20091.0\u00a0g\/dL, albumin\/ascitic ratio\u2009&lt;\u20092.5 [2 points], MELD\u2009\u2265\u200915, diabetes, multidrug-resistant organism [MDRO] infection, and non-use of \u03b2-blockers) stratified the risk of recurrence into low (0\u20133: 15%), moderate (4\u20136: 45%), and high (7\u201310: 80%) categories. Machine learning models outperformed supervised machine logistic regression in predicting recurrence. Logistic regression achieved 70% accuracy, 65% sensitivity, and 68% specificity. The decision tree model improved accuracy to 75%, sensitivity to 72%, and specificity to 71%. The random forest model showed the best performance with 78% accuracy, 77% sensitivity, and 76% specificity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A composite score, combined with machine-learning models like random forest, enhances risk assessment for SBP recurrence. Clinical predictors such as AKI, CRP, bilirubin, MELD, PPI use, and \u03b2-blockers non-use help in targeted prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13099-025-00774-5","type":"journal-article","created":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T02:53:24Z","timestamp":1765076004000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk stratification of spontaneous bacterial peritonitis recurrence: integrating acute kidney injury, biomarkers, composite scores, and machine learning models"],"prefix":"10.1186","volume":"17","author":[{"given":"Nasser","family":"Mousa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Elmetwalli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Abdelsalam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Wahba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Selim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Nour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Abdelkader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"El-Eraky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amany","family":"Hasson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed E","family":"Taha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Mousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel","family":"El-Assmy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"El-Assmy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif","family":"Shiha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Diasty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Abdelaziz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shereen A.","family":"Mourad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader","family":"Elmalky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"issue":"1","key":"774_CR1","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1136\/gutjnl-2020-321790","volume":"70","author":"GP Aithal","year":"2021","unstructured":"Aithal GP, Palaniyappan N, China L, H\u00e4rm\u00e4l\u00e4 S, Macken L, Ryan JM, et al. Guidelines on the management of ascites in cirrhosis. Gut. 2021;70(1):9\u201329.","journal-title":"Gut"},{"issue":"4","key":"774_CR2","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1016\/j.jhep.2021.12.022","volume":"76","author":"R De Franchis","year":"2022","unstructured":"De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Abraldes JG, et al. Baveno VII\u2013renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959\u201374.","journal-title":"J Hepatol"},{"key":"774_CR3","doi-asserted-by":"crossref","unstructured":"Niu C, Zhang J, Himal K, Zhu K, Zachary T, Verghese B, Jadhav N, Okolo PI, Daglilar E, Kouides P. Impact of anticoagulation therapy on outcomes in patients with cirrhosis and portal vein thrombosis: A large-scale retrospective cohort study. Thrombosis Research. 2024; 241:109103.","DOI":"10.1016\/j.thromres.2024.109103"},{"key":"774_CR4","doi-asserted-by":"crossref","unstructured":"Niu C, Zhang J, Daniel-Jose ID, Zachary T, Abdullah O, Shah P,Basant E, Maity D, Abdullah FA, Jadhav N, Okolo PI, Ebubekir D. Anticoagulationoutcomes in cirrhotic patients with portal vein thrombosis: a tertiary center study. PostgradMed J. 2025 Oct 18;101(1201):1166-1172.","DOI":"10.1093\/postmj\/qgaf062"},{"issue":"4","key":"774_CR5","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1053\/jhep.2003.50119","volume":"37","author":"LT Evans","year":"2003","unstructured":"Evans LT, Kim RW, Poterucha JJ, Kamath PS. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites. Hepatology. 2003;37(4):897\u2013901.","journal-title":"Hepatology"},{"issue":"10","key":"774_CR6","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1097\/MEG.0000000000000700","volume":"28","author":"AM Oliveira","year":"2016","unstructured":"Oliveira AM, Branco JC, Barosa R, Rodrigues JA, Ramos L, Martins A, et al. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study. Eur J Gastroenterol Hepatol. 2016;28(10):1216\u201322.","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"1","key":"774_CR7","doi-asserted-by":"publisher","DOI":"10.1186\/s13099-024-00610-2","volume":"16","author":"N Mousa","year":"2024","unstructured":"Mousa N, Salah M, Elbaz S, Elmetwalli A, Elhammady A, Abdelkader E, et al. Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study. Gut Pathog. 2024;16(1):18.","journal-title":"Gut Pathog"},{"issue":"1","key":"774_CR8","first-page":"5","volume":"4","author":"A El Shabrawi","year":"2019","unstructured":"El Shabrawi A, Abdelaziz M, Mousa N. Infections in cirrhotic patients. Med J Viral Hepat. 2019;4(1):5\u201314.","journal-title":"Med J Viral Hepat"},{"issue":"7","key":"774_CR9","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1111\/j.1572-0241.2007.01286.x","volume":"102","author":"L Christou","year":"2007","unstructured":"Christou L, Pappas G, Falagas ME. Bacterial infection-related morbidity and mortality in cirrhosis. Am J Gastroenterol. 2007;102(7):1510\u20137.","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"774_CR10","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/j.1478-3231.2010.02377.x","volume":"31","author":"CH Huang","year":"2011","unstructured":"Huang CH, Lin CY, Sheen IS, Chen WT, Lin TN, Ho YP, et al. Recurrence of spontaneous bacterial peritonitis in cirrhotic patients non-prophylactically treated with norfloxacin: serum albumin as an easy but reliable predictive factor. Liver Int. 2011;31(2):184\u201391.","journal-title":"Liver Int"},{"issue":"4","key":"774_CR11","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1097\/00004836-200110000-00007","volume":"33","author":"AVC Fran\u00e7a","year":"2001","unstructured":"Fran\u00e7a AVC, De Souza JB, Silva CM, Soares EC. Long-term prognosis of cirrhosis after spontaneous bacterial peritonitis treated with ceftriaxone. J Clin Gastroenterol. 2001;33(4):295\u20138.","journal-title":"J Clin Gastroenterol"},{"issue":"1","key":"774_CR12","doi-asserted-by":"publisher","first-page":"13","DOI":"10.21608\/mjvh.2018.55751","volume":"3","author":"S Amr","year":"2018","unstructured":"Amr S, Ahmed A-R, Hoda E. Spontaneous bacterial peritonitis: an overview. Med J Viral Hepat. 2018;3(1):13\u20137.","journal-title":"Med J Viral Hepat"},{"issue":"3","key":"774_CR13","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.13457","volume":"74","author":"P Termsinsuk","year":"2020","unstructured":"Termsinsuk P, Auesomwang C. Factors that predict recurrent spontaneous bacterial peritonitis in cirrhotic patients. Int J Clin Pract. 2020;74(3):e13457.","journal-title":"Int J Clin Pract"},{"issue":"1","key":"774_CR14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1002\/hep.1840080107","volume":"8","author":"L Tit\u00f3","year":"1988","unstructured":"Tit\u00f3 L, Rimola A, Gin\u00e8s P, Llach J, Arroyo V, Rod\u00e9s J. Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors. Hepatology. 1988;8(1):27\u201331.","journal-title":"Hepatology"},{"issue":"8","key":"774_CR15","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1097\/MEG.0000000000001364","volume":"31","author":"A Abdel-Razik","year":"2019","unstructured":"Abdel-Razik A, Mousa N, Abdel-Aziz M, Elsherbiny W, Zakaria S, Shabana W, et al. Mansoura simple scoring system for prediction of spontaneous bacterial peritonitis: lesson learnt. Eur J Gastroenterol Hepatol. 2019;31(8):1017\u201324.","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"4","key":"774_CR16","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1136\/gut.2004.048181","volume":"54","author":"U Thalheimer","year":"2005","unstructured":"Thalheimer U, Triantos CK, Samonakis DN, Patch D, Burroughs AK. Infection, coagulation, and variceal bleeding in cirrhosis. Gut. 2005;54(4):556\u201363.","journal-title":"Gut"},{"issue":"4","key":"774_CR17","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1002\/hep.28737","volume":"64","author":"G Dam","year":"2016","unstructured":"Dam G, Vilstrup H, Watson H, Jepsen P. Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites. Hepatology. 2016;64(4):1265\u201372.","journal-title":"Hepatology"},{"issue":"2","key":"774_CR18","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/09674845.2017.1396706","volume":"75","author":"N Mousa","year":"2018","unstructured":"Mousa N, Besheer T, Abdel-Razik A, Hamed M, Deiab AG, Sheta T, et al. Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis? Br J Biomed Sci. 2018;75(2):71\u20135.","journal-title":"Br J Biomed Sci"},{"issue":"5","key":"774_CR19","doi-asserted-by":"publisher","first-page":"6161","DOI":"10.1007\/s11033-011-1432-8","volume":"39","author":"K-Q Shi","year":"2012","unstructured":"Shi K-Q, Fan Y-C, Ying L, Lin X-F, Song M, Li L-F, et al. Risk stratification of spontaneous bacterial peritonitis in cirrhosis with ascites based on classification and regression tree analysis. Mol Biol Rep. 2012;39(5):6161\u20139.","journal-title":"Mol Biol Rep"},{"issue":"2","key":"774_CR20","doi-asserted-by":"publisher","first-page":"170","DOI":"10.3390\/gastroent14020013","volume":"14","author":"NH Cao","year":"2023","unstructured":"Cao NH, Ho PT, Bui HH, Vo TD. Non-invasive methods for the prediction of spontaneous bacterial peritonitis in patients with cirrhosis. Gastroenterol Insights. 2023;14(2):170\u20137.","journal-title":"Gastroenterol Insights"},{"issue":"3","key":"774_CR21","doi-asserted-by":"publisher","first-page":"63","DOI":"10.37737\/ace.22009","volume":"4","author":"S Ono","year":"2022","unstructured":"Ono S, Goto T. Introduction to supervised machine learning in clinical epidemiology. Annals of Clinical Epidemiology. 2022;4(3):63\u201371.","journal-title":"Annals of Clinical Epidemiology"},{"issue":"2","key":"774_CR22","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","volume":"69","author":"P Angeli","year":"2018","unstructured":"Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406\u201360.","journal-title":"J Hepatol"},{"issue":"4","key":"774_CR23","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1002\/hep.26359","volume":"57","author":"BA Runyon","year":"2013","unstructured":"Runyon BA. Introduction to the revised American association for the study of liver diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651\u20133.","journal-title":"Hepatology"},{"issue":"1","key":"774_CR24","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jhep.2024.03.031","volume":"81","author":"MK Nadim","year":"2024","unstructured":"Nadim MK, Kellum JA, Forni L, Francoz C, Asrani SK, Ostermann M, et al. Acute kidney injury in patients with cirrhosis: acute disease quality initiative (ADQI) and international club of ascites (ICA) joint multidisciplinary consensus meeting. J Hepatol. 2024;81(1):163\u201383.","journal-title":"J Hepatol"},{"issue":"3","key":"774_CR25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1440-1746.1995.tb01096.x","volume":"10","author":"R Gupta","year":"1995","unstructured":"Gupta R, Misra SP, Dwivedi M, Misra V, Kumar S, Gupta SC. Diagnosing ascites: value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum-ascites albumin and cholesterol gradient. J Gastroenterol Hepatol. 1995;10(3):295\u20139.","journal-title":"J Gastroenterol Hepatol"},{"issue":"2","key":"774_CR26","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2013.19.2.99","volume":"19","author":"C Chung","year":"2013","unstructured":"Chung C, Iwakiri Y. The lymphatic vascular system in liver diseases: its role in ascites formation. Clin Mol Hepatol. 2013;19(2):99.","journal-title":"Clin Mol Hepatol"},{"key":"774_CR27","unstructured":"Chen SM, Lo GH, Lai KH, Cheng HH, Cheng JS, Shen MT, et al. Serum and ascitic concentration of C3, C4 and protein in cirrhotic patients with spontaneous bacterial peritonitis. Zhonghua Yi Xue Za zhi\u2009=\u2009Chinese medical Journal; free China ed. 1994;54(2):87\u201392."},{"issue":"5","key":"774_CR28","doi-asserted-by":"publisher","DOI":"10.2144\/fsoa-2023-0016","volume":"9","author":"M Moalla","year":"2023","unstructured":"Moalla M, Elleuch N, Dahmani W, Hammami A, Ameur WB, Slama AB, et al. Predictive factors of recurrence in spontaneous bacterial peritonitis in Tunisian patients with cirrhosis. Future Sci OA. 2023;9(5):FSO857.","journal-title":"Future Sci OA"},{"issue":"7","key":"774_CR29","first-page":"407","volume":"21","author":"S Jamil","year":"2011","unstructured":"Jamil S, Ahmed S, Memon A, Masood S, Shah SH, Hamid SS, Jafri W. Factors predicting the recurrence of spontaneous bacterial peritonitis in patients with cirrhosis. JCPSP: J Coll Physicians Surgeons\u2013Pakistan. 2011;21(7):407.","journal-title":"JCPSP: J Coll Physicians Surgeons\u2013Pakistan"},{"issue":"7","key":"774_CR30","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1053\/j.gastro.2014.03.005","volume":"146","author":"M Mandorfer","year":"2014","unstructured":"Mandorfer M, Bota S, Schwabl P, Bucsics T, Pfisterer N, Kruzik M, Hagmann M, Blacky A, Ferlitsch A, Sieghart W. Nonselective \u03b2 blockers increase risk for hepatorenal syndrome and death in patients with cirrhosis and spontaneous bacterial peritonitis. Gastroenterology. 2014;146(7):1680\u201390.","journal-title":"Gastroenterology"},{"issue":"3","key":"774_CR31","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1002\/hep.23775","volume":"52","author":"T Serst\u00e9","year":"2010","unstructured":"Serst\u00e9 T, Melot C, Francoz C, Durand F, Rautou PE, Valla D, et al. Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites. Hepatology. 2010;52(3):1017\u201322.","journal-title":"Hepatology"},{"issue":"8","key":"774_CR32","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1111\/j.1478-3231.2009.02038.x","volume":"29","author":"M Senzolo","year":"2009","unstructured":"Senzolo M, Cholongitas E, Burra P, Leandro G, Thalheimer U, Patch D, et al. \u03b2-blockers protect against spontaneous bacterial peritonitis in cirrhotic patients: a meta\u2010analysis. Liver Int. 2009;29(8):1189\u201393.","journal-title":"Liver Int"},{"issue":"9","key":"774_CR33","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1111\/liv.12210","volume":"33","author":"M de Vos","year":"2013","unstructured":"de Vos M, De Vroey B, Garcia BG, Roy C, Kidd F, Henrion J, et al. Role of proton pump inhibitors in the occurrence and the prognosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Liver Int. 2013;33(9):1316\u201323.","journal-title":"Liver Int"},{"issue":"7","key":"774_CR34","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1111\/j.1365-2362.2011.02643.x","volume":"42","author":"LG van Vlerken","year":"2012","unstructured":"van Vlerken LG, Huisman EJ, van Hoek B, Renooij W, de Rooij FWM, Siersema PD, et al. Bacterial infections in cirrhosis: role of proton pump inhibitors and intestinal permeability. Eur J Clin Invest. 2012;42(7):760\u20137.","journal-title":"Eur J Clin Invest"},{"issue":"1","key":"774_CR35","doi-asserted-by":"publisher","DOI":"10.1186\/s13099-021-00414-8","volume":"13","author":"S Alhumaid","year":"2021","unstructured":"Alhumaid S, Al Mutair A, Al Alawi Z, Zaidi ARZ, Rabaan AA, Elhazmi A, et al. Proton pump inhibitors use and risk of developing spontaneous bacterial peritonitis in cirrhotic patients: a systematic review and meta-analysis. Gut Pathog. 2021;13(1):17.","journal-title":"Gut Pathog"},{"issue":"3","key":"774_CR36","first-page":"327","volume":"36","author":"A Boustany","year":"2023","unstructured":"Boustany A, Rahhal R, Onwuzo S, Almomani A, Boustany T, Kumar P, Asaad I. Cirrhotic patients on proton pump inhibitors are at a twofold risk of spontaneous bacterial peritonitis independently of Gastrointestinal bleeding: a population-based retrospective study. Annals Gastroenterol. 2023;36(3):327.","journal-title":"Annals Gastroenterol"},{"issue":"6","key":"774_CR37","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1002\/hep.1840200619","volume":"20","author":"A Follo","year":"1994","unstructured":"Follo A, Llovet JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology. 1994;20(6):1495\u2013501.","journal-title":"Hepatology"},{"issue":"3","key":"774_CR38","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.cgh.2010.11.038","volume":"9","author":"P Tandon","year":"2011","unstructured":"Tandon P, Garcia\u2013Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2011;9(3):260\u20135.","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"4","key":"774_CR39","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1681\/ASN.2014121218","volume":"27","author":"ED Siew","year":"2016","unstructured":"Siew ED, Parr SK, Abdel-Kader K, Eden SK, Peterson JF, Bansal N, et al. Predictors of recurrent AKI. J Am Soc Nephrol. 2016;27(4):1190\u2013200.","journal-title":"J Am Soc Nephrol"},{"issue":"12","key":"774_CR40","doi-asserted-by":"publisher","first-page":"2732","DOI":"10.1111\/j.1572-0241.2007.01485.x","volume":"102","author":"KL Obstein","year":"2007","unstructured":"Obstein KL, Campbell MS, Reddy KR, Yang Y-X. Association between model for end-stage liver disease and spontaneous bacterial peritonitis. Am J Gastroenterol. 2007;102(12):2732\u20136.","journal-title":"Am J Gastroenterol"},{"issue":"1","key":"774_CR41","first-page":"92","volume":"36","author":"T-H Hung","year":"2024","unstructured":"Hung T-H, Ko P-H, Wang C-Y, Tsai C-C, Lee H-F. Effect of hypoalbuminemia on mortality in cirrhotic patients with spontaneous bacterial peritonitis. Tzu Chi Med J. 2024;36(1):92\u20137.","journal-title":"Tzu Chi Med J"},{"issue":"4","key":"774_CR42","doi-asserted-by":"publisher","first-page":"264","DOI":"10.4103\/ejim.ejim_15_18","volume":"30","author":"S El-Gamal","year":"2018","unstructured":"El-Gamal S, El-Menshawy HHE-B, Abbas NF, El-Metwally O. Acute kidney injury network criteria as a prognostic factor in cirrhotic patients with spontaneous bacterial peritonitis. Egypt J Intern Med. 2018;30(4):264\u201370.","journal-title":"Egypt J Intern Med"},{"issue":"4","key":"774_CR43","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.jceh.2017.05.004","volume":"7","author":"A Nuthalapati","year":"2017","unstructured":"Nuthalapati A, Schluterman N, Khanna A, Greenberg D, Thuluvath PJ. Impact of acute kidney injury on mortality of patients hospitalized for complications of cirrhosis. J Clin Exp Hepatol. 2017;7(4):290\u20139.","journal-title":"J Clin Exp Hepatol"},{"issue":"2","key":"774_CR44","doi-asserted-by":"publisher","first-page":"6","DOI":"10.21608\/mjvh.2024.399818","volume":"8","author":"A Elmetwalli","year":"2024","unstructured":"Elmetwalli A, Hassan J, Ismail N, Rizk R, Abdelaziz M, Mohamed S, Salama H, Abdelkader E. C-reactive protein to albumin ratio: A new score for predicting the recurrence of spontaneous bacterial peritonitis in cirrhotic patients with Ascites. Med J Viral Hepat. 2024;8(2):6\u20138.","journal-title":"Med J Viral Hepat"},{"issue":"2","key":"774_CR45","first-page":"25","volume":"2","author":"N Mousa","year":"2018","unstructured":"Mousa N, Zakaria S, Maksoud MAEL, Shabana W, Effat N, Awad M, Abd Elmohsen Eldesoky TS, El-Wakeel N, Moemen D, Mikhail N. The predictive factors for recurrence of spontaneous bacterial peritonitis. Med J Viral Hepat. 2018;2(2):25\u20139.","journal-title":"Med J Viral Hepat"},{"issue":"6","key":"774_CR46","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1053\/j.gastro.2014.01.020","volume":"146","author":"B Schnabl","year":"2014","unstructured":"Schnabl B, Brenner DA. Interactions between the intestinal microbiome and liver diseases. Gastroenterology. 2014;146(6):1513\u201324.","journal-title":"Gastroenterology"},{"key":"774_CR47","doi-asserted-by":"publisher","DOI":"10.1177\/1756284820942616","volume":"13","author":"C Skinner","year":"2020","unstructured":"Skinner C, Thompson AJ, Thursz MR, Marchesi JR, Vergis N. Intestinal permeability and bacterial translocation in patients with liver disease, focusing on alcoholic aetiology: methods of assessment and therapeutic intervention. Ther Adv Gastroenterol. 2020;13:1756284820942616.","journal-title":"Ther Adv Gastroenterol"},{"issue":"4","key":"774_CR48","first-page":"272","volume":"44","author":"R Alhajaji","year":"2024","unstructured":"Alhajaji R, Samkari MM, Althobaiti MA, Al-Ahmadi BR, Bugis AM, Bugis AM, et al. Diabetes mellitus and the risk of spontaneous bacterial peritonitis in patients with liver cirrhosis: a systematic review and meta-analysis. Ann Saudi Med. 2024;44(4):272\u201387.","journal-title":"Ann Saudi Med"},{"issue":"39","key":"774_CR49","doi-asserted-by":"publisher","first-page":"14079","DOI":"10.3748\/wjg.v20.i39.14079","volume":"20","author":"AA de Mattos","year":"2014","unstructured":"de Mattos AA, Costabeber AM, Lion\u00e7o LC, Tovo CV. Multi-resistant bacteria in spontaneous bacterial peritonitis: a new step in management? World J Gastroenterol. 2014;20(39):14079.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"774_CR50","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-023-02919-9","volume":"23","author":"NC Huynh","year":"2023","unstructured":"Huynh NC, Vo TD. Validation of a new simple scoring system to predict spontaneous bacterial peritonitis in patients with cirrhosis and ascites. BMC Gastroenterol. 2023;23(1):272.","journal-title":"BMC Gastroenterol"},{"issue":"1","key":"774_CR51","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.annemergmed.2022.01.046","volume":"80","author":"K Dash","year":"2022","unstructured":"Dash K, Goodacre S, Sutton L. Composite outcomes in clinical prediction modeling: are we trying to predict apples and oranges? Ann Emerg Med. 2022;80(1):12\u20139.","journal-title":"Ann Emerg Med"},{"issue":"1","key":"774_CR52","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05489-x","volume":"22","author":"EH Weissler","year":"2021","unstructured":"Weissler EH, Naumann T, Andersson T, Ranganath R, Elemento O, Luo Y, et al. The role of machine learning in clinical research: transforming the future of evidence generation. Trials. 2021;22(1):537.","journal-title":"Trials"},{"issue":"1","key":"774_CR53","doi-asserted-by":"publisher","DOI":"10.1186\/s12859-018-2264-5","volume":"19","author":"R Couronn\u00e9","year":"2018","unstructured":"Couronn\u00e9 R, Probst P, Boulesteix A-L. Random forest versus logistic regression: a large-scale benchmark experiment. BMC Bioinformatics. 2018;19(1):270.","journal-title":"BMC Bioinformatics"}],"container-title":["Gut Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13099-025-00774-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13099-025-00774-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13099-025-00774-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T06:02:12Z","timestamp":1765519332000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13099-025-00774-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,7]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["774"],"URL":"https:\/\/doi.org\/10.1186\/s13099-025-00774-5","relation":{},"ISSN":["1757-4749"],"issn-type":[{"value":"1757-4749","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,7]]},"assertion":[{"value":"27 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval was obtained from the Institutional Review Board (IRB) at ELH with the approved number #CT-2024-005, and all procedures adhered to privacy regulations. All patients and\/or their legal guardian(s) must provide written informed consent before participation in any protocol-specific procedure. All methods were carried out following the guidelines and regulations of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"103"}}