Abstract
Ascitic fluid infection is a major cause of morbidity and mortality in cirrhotic patients, requiring early diagnosis and therapy. We aimed to determine predictors of ascitic fluid infection in children with chronic liver disease. The study included 45 children with chronic liver disease and ascites who underwent 66 paracentesis procedures. Full history taking and clinical examination of all patients were obtained including fever, abdominal pain and tenderness and respiratory distress. Investigations included: complete blood count, C-reactive protein, full liver function tests, ascitic fluid biochemical analysis, cell count and culture. Our results showed that patients’ ages ranged between 3 months to 12 years. Prevalence of ascitic fluid infection was 33.3%. Gram-positive bacteria were identified in six cases, and Gram-negative bacteria in five. Fever and abdominal pain were significantly more associated with infected ascites (p value = 0.004, 0.006). Patients with ascitic fluid infection had statistically significant elevated absolute neutrophilic count and C-reactive protein. Logistic regression analysis showed that fever, abdominal pain, elevated absolute neutrophilic count and positive C-reactive protein are independent predictors of ascitic fluid infection. Fever, elevated absolute neutrophilic count and positive C-reactive protein raise the probability of ascitic fluid infection by 3.88, 9.15 and 4.48 times respectively. The cut-off value for C-reactive protein for ascitic fluid infection was 7.2 with sensitivity 73% and specificity of 71%. In conclusion, prevalence of ascitic fluid infection in pediatric patients with chronic liver disease and ascites was 33.3%. Fever, abdominal pain, positive C-reactive protein and elevated absolute neutrophilic count are strong predictors of ascitic fluid infection. Therefore an empirical course of first-line antibiotics should be immediately started with presence of any of these predictors after performing ascitic fluid tapping for culture and sensitivity. In absence of these infection parameters, routine ascitic fluid analysis could be spared.
Highlights
Ascites is a common problem in patients with chronic liver disease (CLD), which develops secondary to intrahepatic portal hypertension [1]
The study included 45 children with CLD and ascites with a total of 66 paracentesis procedures performed (7 patients had done more than 1 paracentesis in a different period of time more than 3 weeks from the previous paracentesis)
The remaining 41 procedures were diagnostic for suspicion of Diagnosis Biliary atresia Idiopathic neonatal hepatitis Progressive familial intrahepatic cholestasis I and II Hepatic venous outflow obstruction Cryptogenic cirrhosis Niemann-Pick disease Wilson disease Tyrosinemia Congenital hepatic fibrosis Autoimmune hepatitis
Summary
Ascites is a common problem in patients with chronic liver disease (CLD), which develops secondary to intrahepatic portal hypertension [1]. Ascitic fluid analysis in children infections with a higher prevalence in cirrhotics [2]. Ascitic fluid infection (AFI) represents a major cause of morbidity and mortality in cirrhotic patients [2]. With early diagnosis and prompt initiation of appropriate therapy, recent reports showed dramatic decline in mortality rates secondary to AFI compared to older studies [6,7]. About 28–43% of liver disease-related ascites have AFI with 24% 1-year mortality [1,8]
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