{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:56:52Z","timestamp":1790287012848,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of cirrhosis associated with high morbidity and mortality. Early risk stratification remains challenging due to the invasive nature of ascitic polymorphonuclear cell counting and the limited sensitivity of conventional markers. Novel composite biomarkers such as the blood urea nitrogen\/albumin ratio (BAR), red cell distribution width\/albumin ratio (RAR), and neutrophil-to-lymphocyte ratio (NLR) may offer practical prognostic value. This study aimed to evaluate the predictive power of these biomarkers for in-hospital mortality in patients diagnosed with SBP in the emergency department. Methods: This retrospective, observational, cohort study included adult patients diagnosed with SBP between March 2022 and October 2024. SBP diagnosis was confirmed by ascitic fluid leukocyte count &gt; 250\/mm3. Demographic data, laboratory parameters, and clinical outcomes were obtained from hospital records. RAR and BAR ratios were calculated at admission. Outcomes were analyzed according to ward\/intensive care unit (ICU) admission and in-hospital mortality. Receiver operating characteristic (ROC) analysis and logistic regression were performed to assess prognostic performance. Results: A total of 112 patients were included (mean age 63.44 \u00b1 13.16 years, 56.3% male). In-hospital mortality was 43.8%. Both BAR and RAR ratios were significantly higher in non-survivors (p = 0.016 and p = 0.001, respectively). BAR showed the highest prognostic performance (Area under the curve 0.761), with an optimal cutoff &gt; 1.86 (sensitivity 64.44%, specificity 79.66%). RAR had an area under the curve (AUC) of 0.638, and NLR had an AUC of 0.658. Conclusions: Among the evaluated biomarkers, BAR emerged as the strongest predictor of in-hospital mortality in SBP, outperforming both RAR and NLR. Although albumin alone was not predictive, its use in composite ratios improved prognostic accuracy. These easily accessible biomarkers may support early risk stratification in emergency settings.<\/jats:p>","DOI":"10.3390\/jcm15010208","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:50:42Z","timestamp":1766969442000},"page":"208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Prognostic Value of Biomarkers in Patients Diagnosed with Spontaneous Bacterial Peritonitis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1477-6363","authenticated-orcid":false,"given":"S\u00fcleyman","family":"K\u0131r\u0131k","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-1239","authenticated-orcid":false,"given":"Mehmet G\u00f6ktu\u011f","family":"Efgan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-2337","authenticated-orcid":false,"given":"Ejder Saylav","family":"Bora","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0208-950X","authenticated-orcid":false,"given":"Efe","family":"Kanter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1490-8840","authenticated-orcid":false,"given":"Ecem","family":"Ermete G\u00fcler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Izmir Katip \u00c7elebi University, 35100 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9641-4176","authenticated-orcid":false,"given":"Tutku","family":"Duman \u015eahan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Izmir \u00c7e\u015fme Alper \u00c7izgenakat State Hospital, 35950 Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.ajem.2023.05.015","article-title":"Emergency medicine updates: Spontaneous bacterial peritonitis","volume":"70","author":"Long","year":"2023","journal-title":"Am. J. Emerg. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Du, T., Li, Q., Jiang, G., Tan, H.-Y., Wu, J.-H., Qin, S.-Y., Yu, B., Jiang, H.-X., and Luo, W. (2023). Systematically analysis of decompensated cirrhotic patients with spontaneous bacterial peritonitis to identify diagnostic and prognostic indexes. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08731-w"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13099-024-00610-2","article-title":"Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: A prospective multicenter study","volume":"16","author":"Mousa","year":"2024","journal-title":"Gut Pathog."},{"key":"ref_4","first-page":"e33124","article-title":"Efficacy of Intravenous Albumin for Spontaneous Bacterial Peritonitis Infection Among Patients with Cirrhosis: A Meta-Analysis of Randomized Control Trials","volume":"14","author":"Batool","year":"2022","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"82","DOI":"10.61796\/jmgcb.v1i10.1009","article-title":"Laboratory characteristics of patients with liver cirrhosis of virus etiology complicated with spontaneous bacterial peritonitis","volume":"1","author":"Oblokulov","year":"2024","journal-title":"Eur. J. Med. Genet. Clin. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Aslam, H., Oza, F., Ahmed, K., Kopel, J., Aloysius, M.M., Ali, A., Dahiya, D.S., Aziz, M., Perisetti, A., and Goyal, H. (2023). The role of red cell distribution width as a prognostic marker in chronic liver disease: A literature review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24043487"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1177\/0897190021997002","article-title":"Albumin utilization in spontaneous bacterial peritonitis","volume":"35","author":"Ebied","year":"2021","journal-title":"J. Pharm. Pract."},{"key":"ref_8","unstructured":"Abdelrahman, S., Ahmed, E., Roshdy, M., Abdelazim, O., Hamdy, L., and Hassan, H. (2025). Study of the Role of Novel Biomarkers for Early Detection of SBP. Egypt. J. Hosp. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jiang, Y., Fan, C., Dang, Y., Zhao, W., Lv, L., Lou, J., Li, L., and Ding, H. (2023). Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis\/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case\u2013Control Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093100"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"W\u00fcrstle, S., Hapfelmeier, A., Karapetyan, S., Studen, F., Isaakidou, A., Schneider, T., Schmid, R.M., von Delius, S., Gundling, F., and Burgkart, R. (2023). Differentiation of Spontaneous Bacterial Peritonitis from Secondary Peritonitis in Patients with Liver Cirrhosis: Retrospective Multicentre Study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13050994"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3390\/gastroent14020013","article-title":"Non-Invasive Methods for the Prediction of Spontaneous Bacterial Peritonitis in Patients with Cirrhosis","volume":"14","author":"Cao","year":"2023","journal-title":"Gastroenterol. Insights"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Gruszecka, J., and Filip, R. (2024). Epidemiological Study of Pathogens in Spontaneous Bacterial Peritonitis in 2017\u20132024\u2014A Preliminary Report of the University Hospital in South-Eastern Poland. Microorganisms, 12.","DOI":"10.3390\/microorganisms12051008"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Maccauro, V., Airola, C., Santopaolo, F., Gasbarrini, A., Ponziani, F.R., and Pompili, M. (2023). Gut Microbiota and Infectious Complications in Advanced Chronic Liver Disease: Focus on Spontaneous Bacterial Peritonitis. Life, 13.","DOI":"10.3390\/life13040991"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99506","DOI":"10.3748\/wjg.v31.i6.99506","article-title":"Procalcitonin and presepsin for detecting bacterial infection and spontaneous bacterial peritonitis in cirrhosis: A systematic review and meta-analysis","volume":"31","author":"Wejnaruemarn","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lin, Y., Chen, W., Wu, T., Liu, Y., Liu, L., Teng, W., Hsieh, Y., Wu, Y., Huang, C., and Hsu, C. (2023). A Validated Composite Score Demonstrates Potential Superiority to MELD-Based Systems in Predicting Short-Term Survival in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis\u2014A Preliminary Study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13152578"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.21037\/tgh-20-323","article-title":"Ascitic calprotectin and lactoferrin for detection of spontaneous bacterial peritonitis: A systematic review and meta-analysis","volume":"7","author":"Patel","year":"2021","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/MEG.0000000000002524","article-title":"Outcomes after Hospitalisation with Spontaneous Bacterial Peritonitis over a 13-Year Period: A Retrospective Cohort Study","volume":"35","author":"Ubhi","year":"2023","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"497","DOI":"10.56303\/jhnresearch.v4i2.497","article-title":"Evaluation of C-reactive protein, neutrophil-to-lymphocyte ratio, and absolute neutrophil count as simple diagnostic markers for spontaneous bacterial peritonitis","volume":"4","author":"Putri","year":"2025","journal-title":"J. Health Nutr. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Efgan, M., Acar, H., Kanter, E., K\u0131r\u0131k, S., and \u015eahan, T. (2024). Role of systemic immune inflammation index, systemic immune response index, neutrophil lymphocyte ratio and platelet lymphocyte ratio in predicting peritoneal culture positivity and prognosis in cases of spontaneous bacterial peritonitis admitted to the emergency department. Medicina, 60.","DOI":"10.3390\/medicina60081335"},{"key":"ref_20","first-page":"852","article-title":"Bacterial DNA is a prognostic factor for mortality in patients who recover from spontaneous bacterial peritonitis","volume":"34","author":"Mani","year":"2021","journal-title":"Ann. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1097\/MEG.0000000000001111","article-title":"Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers","volume":"30","author":"Iliaz","year":"2018","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/23744235.2020.1717599","article-title":"Red cell distribution width\/albumin ratio is associated with 60-day mortality in patients with acute respiratory distress syndrome","volume":"52","author":"Yoo","year":"2020","journal-title":"Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Li, J., Pang, S., Huang, H., Lu, Y., Tang, T., Wu, J., and Chen, M. (2025). Association between red cell distribution width-to-albumin ratio and all-cause mortality in critically ill cirrhotic patients with sepsis: A retrospective analysis of the MIMIC-IV database. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1610726"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Xu, W., Huo, J., Chen, G., Yang, K., Huang, Z., Peng, L., Xu, J., and Jiang, J. (2022). Association between red blood cell distribution width to albumin ratio and prognosis of patients with sepsis: A retrospective cohort study. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1019502"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Jeong, J., Heo, M., Lee, S., Jeong, Y.Y., Lee, J.D., and Yoo, J.-W. (2021). Clinical usefulness of red cell distribution width\/albumin ratio to discriminate 28-day mortality in critically ill patients with pneumonia receiving invasive mechanical ventilation compared with lactate\/albumin ratio: A retrospective cohort study. Diagnostics, 11.","DOI":"10.3390\/diagnostics11122344"},{"key":"ref_26","first-page":"151","article-title":"Diagnostic accuracy of mean platelet volume in cirrhotic patients with spontaneous bacterial peritonitis presented to the emergency department","volume":"16","author":"Torabi","year":"2024","journal-title":"Casp. J. Intern. Med."},{"key":"ref_27","first-page":"97891","article-title":"Association of blood urea nitrogen to albumin ratio with mortality in acute pancreatitis","volume":"15","author":"Xia","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ulloque-Badaracco, J., Alarc\u00f3n-Braga, E., Hern\u00e1ndez-Bustamante, E., Al-Kassab-C\u00f3rdova, A., Mosquera-Rojas, M.D., Ulloque-Badaracco, R.R., Huayta-Cortez, M.A., Maita-Arauco, S.H., Herrera-A\u00f1azco, P., and Benites-Zapata, V.A. (2022). Fibrinogen-to-albumin ratio and blood urea nitrogen-to-albumin ratio in COVID-19 patients: A systematic review and meta-analysis. Trop. Med. Infect. Dis., 7.","DOI":"10.3390\/tropicalmed7080150"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"54919","DOI":"10.1038\/s41598-024-54919-8","article-title":"Blood urea nitrogen to albumin ratio is associated with cerebral small vessel diseases","volume":"14","author":"Nam","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e24338","DOI":"10.1002\/jcla.24338","article-title":"Prognostic value of albumin-related ratios in HBV-associated decompensated cirrhosis","volume":"36","author":"Zhang","year":"2022","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_31","first-page":"e81446","article-title":"A novel predictor compared to the model for end-stage liver disease and Child-Turcotte-Pugh scores for predicting 30-day mortality in patients with liver cirrhosis","volume":"17","author":"Dewi","year":"2025","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.annemergmed.2008.02.016","article-title":"Physician clinical impression does not rule out spontaneous bacterial peritonitis in patients undergoing emergency department paracentesis","volume":"52","author":"Chinnock","year":"2008","journal-title":"Ann. Emerg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/208\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T01:12:29Z","timestamp":1766970749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,27]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010208"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010208","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,27]]}}}