{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:10:25Z","timestamp":1785168625442,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, &gt;30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score \u2265 45) and high-risk group (score &lt; 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis.<\/jats:p>","DOI":"10.3390\/diagnostics13050994","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T06:29:06Z","timestamp":1678084146000},"page":"994","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Differentiation of Spontaneous Bacterial Peritonitis from Secondary Peritonitis in Patients with Liver Cirrhosis: Retrospective Multicentre Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0787-3894","authenticated-orcid":false,"given":"Silvia","family":"W\u00fcrstle","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"},{"name":"Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6765-6352","authenticated-orcid":false,"given":"Alexander","family":"Hapfelmeier","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"},{"name":"Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siranush","family":"Karapetyan","sequence":"additional","affiliation":[{"name":"Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Studen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2680-8492","authenticated-orcid":false,"given":"Andriana","family":"Isaakidou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-2507","authenticated-orcid":false,"given":"Tillman","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland M.","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"von Delius","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, RoMed Hospital Rosenheim, Pettenkoferstr. 10, 83022 Rosenheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8771-2996","authenticated-orcid":false,"given":"Felix","family":"Gundling","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Bogenhausen Hospital of the Munich Municipal Hospital Group, Englschalkinger Stra\u00dfe 77, 81925 Munich, Germany"},{"name":"Department of Internal Medicine II, Klinikum am Bruderwald, Sozialstiftung Bamberg, Buger Stra\u00dfe 80, 96049 Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Burgkart","sequence":"additional","affiliation":[{"name":"Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1774-5194","authenticated-orcid":false,"given":"Andreas","family":"Obermeier","sequence":"additional","affiliation":[{"name":"Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Mayr","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-5657","authenticated-orcid":false,"given":"Marc","family":"Ringelhan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Rasch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Lahmer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Geisler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA"},{"name":"Program in Microbiology, Yale School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3875-5367","authenticated-orcid":false,"given":"Christoph D.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0300-0159","authenticated-orcid":false,"given":"Jochen","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany"},{"name":"German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1136\/gutjnl-2020-321790","article-title":"Guidelines on the management of ascites in cirrhosis","volume":"70","author":"Aithal","year":"2021","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). 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