Poor Oral Hygiene Predicts the Presence of Ascitic Fluid Infection in Patients with Decompensated Cirrhosis

Abstract

Background: Ascitic fluid infection [AFI] is one of the important complications of cirrhosis which has poor prognosis. It may be classified as Spontaneous Bacterial Peritonitis (SBP), culture negative neutrocytic ascites (CNNA) or bacteriascites. Bacterial translocation from GI tract is considered to be the most important mechanism that leads to development of AFI. Poor oral hygiene may cause subclinical or persistent infections in cirrhotic patients may act as independent risk factor for adverse outcomes in cirrhotic patients including AFI. Aim:To assess the correlation between AFI in patients with decompensated cirrhosis having poor oral hygiene. Methods: All in patients of cirrhosis with ascites were examined for ascitic fluid analysis including total protein, albumin, glucose, PMN count. Fluid was also inoculated at bedside for cultures. Oral hygiene was examined for all patients by using the dental mirror. OHI-S was calculated after calculating calculus and Debris index to determine good /poor oral hygiene. Results: A total 200 patients of decompensated cirrhosis were enrolled in the study. With mean age of 50.9 + 9.85. There were 78 % males with a mean BMI of 18.9 + 1.9. Alcohol was the major cause of cirrhosis (72%). Mean MELD and CTP were 18.6+7.43 and 10.2 +1.28 . Mean OHI- S was 1.8+1.07. AFI was found in 28%, SBP and CNNA27% was found in 1% and 27 % respectively. On univariate analysis CTP, MELD, BMI, Haemoglobin, Serum protein and Albumin significantly associated with poor oral hygiene (P < 0.001). Poor oral hygiene was found in 59.6 % in patients with AFI compared to 16.9 % in patients without SBP/CNNA (P < 0.001). S – OHI so predicted presence of AFI with a AUROC of 0.83. Conclusion: We suggest screening for oral hygiene in all patients of decompensated cirrhosis as it may be a harbinger of ascitic fluid infection.