Clinical profile and outcome of ascites and spontaneous bacterial peritonitis (SBP) in cirrhotics study

Abstract

Objectives: A prospective of cirrhotic patients with ascites in terms of clinical profile, prevalence and outcome. Methods: All inpatients during 2 years (2006–2008) with cirrhotic ascites were included. Laboratory workup, diagnostic ascitic paracentesis was performed on admission. Ascitic fluid was tested for total cell count, differential count, albumin, total protein and inoculated in blood culture bottles (BacT/ALERT) R AF at bedside. For ease of analysis CNNA and classic SBP were included in a broad group as spontaneous bacterial peritonitis. All patients with ascitic fluid infection were initially treated with 2nd or 3rd generation cephalosporins or penicillin derivatives or fluoroquinolones empirically and later modified as per culture sensitivity. Primary end points included discharge or death. Statistical analysis was done using Student t test, Chi-square/Fisher Exact. Results: Out of 179 most were between 30-70 years with a mean age of 54 with 80% males. Main etiology of cirrhosis was ethanol (69%). Abdominal distension was the commonest presenting symptom followed by fever, abdominal pain, and encephalopathy. In our study 31% had SBP. Abdominal pain and fever were significantly associated with SBP. Culture positivity rate was 80%. Majority was due to E. coli (63%). SBP was significantly associated with higher creatinine, total WBC count (blood), SAAG, lower serum albumin, serum sodium and ascitic fluid proteins. Common complications other than SBP were shock, acute renal failure (37%) and encephalopathy. Mortality rate was 4.5%. Patients with SBP had higher Child's class and MELD scores. Conclusion: This study underlines effectiveness of bedside inoculation of ascitic fluid into blood culture bottles results in better yield. Patients presenting with abdominal pain, fever or encephalopathy, high blood counts, high creatinine, low sodium, low ascitic fluid protein should be suspected of having SBP.