Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study

Lubna Kamani,Umair S Ahmed,Khalid Mumtaz,Ailia W Ali,Wasim Jafri

doi:10.1186/1471-230x-8-59

Lubna Kamani, Umair S Ahmed + Show 3 more

Open Access

https://doi.org/10.1186/1471-230x-8-59

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Journal: BMC gastroenterology	Publication Date: Dec 1, 2008
Citations: 66	License type: cc-by

Affiliation: Aga Khan University Hospital

Abstract

BackgroundAscitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic patients with culture positive (SBP) and culture negative neutrocytic ascites.MethodsWe analyzed 675 consecutive hepatitis B and/or C related cirrhosis patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 patients had AFI; clinical and laboratory parameters of these patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded.ResultsOut of 187 patients with AFI, 44 (23.5%) had SBP while 143 (76.4%) had CNNA. Hepatitis C virus (HCV) infection was the most common cause of cirrhosis in 139 (74.3%) patients. Patients with SBP had high CTP score as compared to CNNA (12.52 ± 1.45 vs. 11.44 ± 1.66); p < 0.001. Platelets count was low in patients with SBP (101 ± 53 × 109/L) as compared to CNNA (132 ± 91 × 109/L), p = 0.005. We found a high creatinine (mg/dl) (1.95 ± 1.0 vs. 1.44 ± 0.85), (p = 0.003) and high prothrombin time (PT) in seconds (24.8 ± 6.6 vs. 22.4 ± 7.2) (p = 0.04) in SBP as compared to CNNA. More patients with SBP (14/44; 31.8%) had blood culture positivity as compare to CNNA (14/143; 9.8%), p = 0.002. Escherichia. Coli was the commonest organism in blood culture in 15/28 (53.5%) patients. SBP group had a higher mortality (11/44; 25%) as compared to CNNA (12/143; 8.4%), p = 0.003. On multiple logistic regression analysis, creatinine >1.1 mg/dl and positive blood culture were the independent predictors of mortality in patients with SBP.ConclusionPatients with SBP have a higher mortality than CNNA. Independent predictors of mortality in SBP are raised serum creatinine and a positive blood culture.

Highlights

Ascitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality
The two groups of AFI patients, i.e., spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA) were matched for age, gender, clinical features, and complications such as upper GI bleed and hepatoma
After multiple logistic regression analysis we found that a creatinine of >1.1 mg/dl and positive blood culture were the independent predictors of mortality in patients with SBP

Summary

Introduction

Ascitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). Ascitic fluid infections (AFI) are frequent and severe complication in cirrhotic patients and have a high morbidity and mortality. Two variants of AFI have been described in medical literature, 1) Spontaneous bacterial peritonitis (SBP) with polymorph nuclear (PMN) count >250/mm and positive ascitic fluid culture without any evidence of external or intra-abdominal source of infection [1] and 2). It was decided that an ascitic fluid PMN count >250/mm in the absence of evidence of abdominal infection is a form of AFI even though the ascitic culture is negative [4]. Studies suggest that the in-hospital mortality in patients with SBP ranges from 20% to 40% [8,9]

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