Peritonitis In Cirrhotic Patients Research Articles

Diagnostic evaluation of leukocyte esterase reagent strip in bedside rapid diagnosis of spontaneous bacterial peritonitis in cirrhotic patients

Background: Spontaneous bacterial peritonitis (SBP) is the most common and serious infection of liver cirrhosis patients with ascites. If not intervened with early antibiotic treatment leads to high morbidity and mortality. Thus, early diagnosis and treatment of SBP are needed for survival. Leukocyte esterase reagent can aid in early diagnosis. Aims and Objectives: This study aimed to assess the diagnostic accuracy of the leukocyte esterase dipstick test for the diagnosis of SBP in resource poor settings. Materials and Methods: This cross-sectional study was conducted during August 2018–January 2019 on patients with cirrhotic liver disease and ascites in a tertiary care medical college hospital, Puducherry. All patients underwent abdominal paracentesis, and ascitic fluid was subjected to cell counts, biochemistry tests, culture, and leukocyte esterase test (Multistrix SG8- Seimens) at 120 s and graded with five levels. Grade 3 was positive (125 polymorphonuclear leukocytes [PMNL]/mL) and grade 4 (<500/mL), which exceeds the threshold for SBP (<250 PMNL/mL). Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: A total of 50 ascitic fluids were analyzed. Nine out of 50 (18%), 16 (32%), and 4 (8%) were positive for cell count method, Leucocyte esterase reagent (LER) test and culture, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for LER test were 6.25%, 91.18%, 25%, 67.39%, and 64%, respectively. Conclusion: The LER strip test is useful for SBP diagnosis in an emergency and resource poor setting. It provides good diagnostic accuracy and high NPV and it is cost effective and better bedside tool for SBP diagnosis.

Clinical features, microbial spectrum, and antibiotic susceptibility patterns of spontaneous bacterial peritonitis in cirrhotic patients

Background and AimsThe microbial spectrum and antimicrobial resistance patterns change over time and vary across regions in patients with spontaneous bacterial peritonitis (SBP). There is an urgent need to clarify the factors associated with in-hospital mortality in these patients. MethodsIn this study, 377 patients with SBP and 794 patients with bacterascites were analyzed for the microbial spectrum, antimicrobial resistance profiles, and laboratory findings. ResultsThe most common pathogens were Escherichia coli (96, 25.5%), Staphylococcus epidermidis (55, 14.6%), and Enterococcus faecium (42, 11.1%). Multidrug-resistant (MDR) bacteria comprised 49.7% of gram-positive bacteria (GPB) and 48.8% of gram-negative bacteria (GNB). The most sensitive antibiotics were amikacin (91.5%), meropenem (89.8%) and piperacillin/tazobactam (87.6%). Extensively drug-resistant (XDR) (OR=51.457, p < 0.001), neutrophil count (OR=1.088, p < 0.001), and the model for end-stage liver disease (MELD) score (OR=1.124, p < 0.001) were independent predictive factors of in-hospital mortality in patients with SBP. ConclusionMDR represented nearly half of the bacteria isolated from patients with SBP, of which the high prevalence of extended-spectrum β-lactamase-producing and Carbapenem-resistant bacteria is concerning. The presence of XDR, higher MELD score, and neutrophil count were independent predictive factors associated with higher in-hospital mortality in patients with SBP, indicating that intensive care should be provided to these patients.

FRI-318 - Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma

FRI-318 - Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma

Clinical Characteristics and Early Diagnosis of Spontaneous Fungal Peritonitis/Fungiascites in Hospitalized Cirrhotic Patients with Ascites: A Case-Control Study.

Spontaneous fungal peritonitis (SFP) and fungiascites is less well-recognized and described in patients with liver cirrhosis. The aims of this study were to determine the clinical characteristics, prognosis, and risk factors of cirrhotic patients with SFP/fungiascites and to improve early differential diagnosis with spontaneous bacterial peritonitis (SBP). This was a retrospective case-control study of 54 cases of spontaneous peritonitis in cirrhotic patients (52 SFP and 2 fungiascites) with fungus-positive ascitic culture. Fifty-four SBP cirrhotic patients with bacteria-positive ascitic culture were randomly enrolled as a control group. A nomogram was developed for the early differential diagnosis of SFP and fungiascites. Hospital-acquired infection was the main cause of SFP/fungiascites. Of the 54 SFP/fungiascites patients, 31 (57.41%) patients carried on with the antifungal treatment, which seemed to improve short-term (30-days) mortality but not long-term mortality. Septic shock and HCC were independent predictors of high 30-day mortality in SFP/fungiascites patients. We constructed a predictive nomogram model that included AKI/HRS, fever, (1,3)-β-D-glucan, and hospital-acquired infection markers for early differential diagnosis of SFP/fungiascites in cirrhotic patients with ascites from SBP, and the diagnostic performance was favorable, with an AUC of 0.930 (95% CI: 0.874-0.985). SFP/fungiascites was associated with high mortality. The nomogram established in this article is a useful tool for identifying SFP/fungiascites in SBP patients early. For patients with strongly suspected or confirmed SFP/fungiascites, timely antifungal therapy should be administered.

Initial treatment response and short-term mortality of spontaneous bacterial peritonitis in cirrhotic patients with hepatocellular carcinoma

This study aimed to investigate the initial treatment response and short-term mortality of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with hepatocellular carcinoma (HCC) compared with those without HCC. A total of 245 patients with liver cirrhosis diagnosed with SBP between January 2004 and December 2020 were included. Of these, 107 (43.7%) were diagnosed with HCC. Overall, the rates of initial treatment failure, 7-day and 30-day mortality were 91 (37.1%), 42 (17.1%), and 89 (36.3%), respectively. While the baseline CTP score, MELD score, culture-positive rate, and rates of antibiotic resistance did not differ between both groups, patients with HCC had a higher rate of initial treatment failure than those without HCC patients (52.3% vs. 25.4%, P < 0.001). Similarly, 30-day mortality was also significantly higher in patients with HCC (53.3% vs. 23.2%, P < 0.001). In the multivariate analysis, HCC, renal impairment, CTP grade C, and antibiotic resistance were independent factors for initial treatment failure. Furthermore, HCC, hepatic encephalopathy, MELD score, and initial treatment failure were independent risk factors for 30-day mortality, with statistically significant poor survival outcomes in patients with HCC (P < 0.001). In conclusion, HCC is an independent risk factor for initial treatment failure and high short-term mortality in patients with cirrhosis with SBP. It has been suggested that more attentive therapeutic strategies are required to improve the prognosis of patients with HCC and SBP.

COMPARING THE EFFICACY OF INTRAVENOUS CIPROFLOXACIN AND CEFTAZIDIME FOR TREATING SPONTANEOUS BACTERIAL PERITONITIS IN LIVER CIRRHOSIS PATIENTS

The aim of current analysis was to compare the efficacy of intravenous ciprofloxacin and ceftazidime for treating spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. A retrospective study was conducted in the Medicine Department of SIMS, Lahore, from September 2021-September 2022. The study selected 110 cirrhosis patients with SBP were included in the study and were divided into two groups, A and B. Group A (n=55) was administered ciprofloxacin intravenously, and group B (n=55) was administered ceftazidime intravenously. The patients diagnosed with type 1 hepatorenal syndrome were treated with albumin and terlipressin daily. The clinical signs and causes of infection did not vary between both groups. The infection was resolved in 50 patients (90.9%) ceftazidime patients and in 51 patients (93%) ciprofloxacin patients. Out of 17 patients who developed, 10 patients (58.8%) completely recovered after terlipressin and albumin treatment, 1 (5.8%) showed partial response, and 6 (35.3%) did not respond. Switch therapy with ciprofloxacin and ceftazidime is equally effective in treating spontaneous bacterial peritonitis in cirrhotic patients with ascites.

Comparative Analysis of Intravenous Ceftriaxone and Ciprofloxacin for the Treatment of Bacterial Peritonitis in Liver Cirrhosis

The Purpose of the current study to Evaluate the efficacy of intravenous ciprofloxacin with ceftriaxone for the treatment of bacterial peritonitis in patients of liver cirrhosis at PIMS Hospital Islamabad from January 2021 to June 2021 at Department of Medicine .A total of 260 patients of liver cirrhosis were selected for this study. Patients were randomly allocated in two groups (Group A and B). Patients aged 13 to 60 years of both genders with established liver cirrhosis, diagnosed on ultrasound abdomen were included in this study. Patients with hemorrhagic or malignant ascites, peritonitis, tuberculosis peritonitis, hepatocellular carcinoma and diabetes mellitus were excluded from study. In group A, 130 patients were given intravenous ciprofloxacin 200mg 12 hourly and in group B 130 patients on ceftriaxone 1g 12 hourly. Treatment was given for 5 days and efficacy of treatment was determined by means of evaluating clinical symptoms. The mean age of the patients in group A was 43.4±10.4 years and in group B was 44.2±10.2 years. In group A there were 90(70%) patients and 95(73.3%) patients in group B in whom spontaneous bacterial peritonitis was settled down. The Result of the current study suggest that Intravenous is as effective as ceftriaxone in the treatment of spontaneous bacterial peritonitis in cirrhotic patients. Keywords: liver cirrhosis, ciprofloxacin, bacterial peritonitis, ceftriaxone

Transforming Growth Factor Beta 1 in the Ascitic Fluid as ‎Predictor for Spontaneous Bacterial Peritonitis in Cirrhotic Patients ‎due to Hepatitis C Virus infection in Suez Canal University ‎Hospital

Transforming Growth Factor Beta 1 in the Ascitic Fluid as ‎Predictor for Spontaneous Bacterial Peritonitis in Cirrhotic Patients ‎due to Hepatitis C Virus infection in Suez Canal University ‎Hospital

Proton Pump Inhibitors Use and Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Retrospective Cohort Analysis.

BackgroundSince their introduction in the early 1980s, proton pump inhibitors (PPIs) have been used worldwide for a broad range of indications. Unfortunately, however, PPIs have become overly prescribed by healthcare providers, sometimes in the absence of clear indications. Although PPIs were initially presumed to have an excellent safety profile, emerging studies have shed light on the association between their long-term use and a myriad of side effects, including the possibility of an increased risk of spontaneous bacterial peritonitis (SBP). Data available to date regarding the association between PPI use and SBP development in cirrhotic patients is conflicting. While some observational studies provide no association between PPI use in cirrhotic patients and an increased risk of SBP development, many others support this association. As a result of the conflicting conclusions from case controls, cohorts, and meta-analyses, we aimed to carry out this retrospective cohort analysis of data from cirrhotic patients included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Our aim was to evaluate for a possible association between PPIs use and the risk of SBP development in cirrhotic patients and to compare the prevalence of SBP development between cirrhotic patients who were actively using PPIs and those who were not.MethodsA retrospective cohort analysis with chart review was conducted on patients with cirrhosis who were included in the electronic medical record-based commercial database, EXPLORYS (IMB-WATSON, Cleveland, Ohio). Using this database, records were reviewed between December 2017 and 2020. Included patients were adults aged 30 to 79 years with a Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of liver cirrhosis. Included patients with a SNOMED-CT diagnosis of liver cirrhosis were divided into two groups: the first group included all cirrhotic patients who did not use PPIs and the second group included all cirrhotic patients who were on PPIs at home.ResultsIn our analysis, SBP occurred in 1.7% (1,860 patients) of the included cirrhotic patients whether they were actively taking PPIs or not. Among the 40,670 cirrhotic patients who were on PPIs at home, 1,350 (3.3%) patients developed SBP. On multivariate analysis, PPI use was the strongest predictor for SBP in cirrhotic patients (odds ratio (OR) = 4.24; 95% confidence interval (CI): 3.83 - 4.7, P value < 0.0001), with cirrhotic patients taking PPIs being 4.24 more likely to develop SBP than those not on PPIs. In addition, PPI use, history of bleeding varices, age, race, and gender were found to be independent predicting factors for SBP, in descending order of importance.ConclusionsOur retrospective cohort analysis has shown that the use of PPIs in patients with liver cirrhosis is an independent predicting risk factor for SBP development. It solidified the argument that cirrhotic patients receiving this form of therapy seem to have a higher risk of developing SBP. In the setting of the emerging evidence that PPIs might impose health risks in cirrhotic patients, further studies are needed to settle the current debate between supporters and opponents of this proposition. In addition, future studies may help clarify the relationship between the occurrence of SBP in cirrhotic patients and the type, dose, and duration of PPIs used. We recommend that unless it is clearly indicated, PPI therapy should be avoided or administered with caution in patients with cirrhosis.

Ascitic Fluid Calprotectin Level as a Diagnostic Marker of Spontaneous Bacterial Peritonitis in Cirrhotic Patients

Spontaneous bacterial peritonitis (SBP) is the infection of pre-existing ascitic fluid without evidence of a secondary infection.

Explainable machine learning model for predicting spontaneous bacterial peritonitis in cirrhotic patients with ascites

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with cirrhosis. We aimed to develop an explainable machine learning model to achieve the early prediction and outcome interpretation of SBP. We used CatBoost algorithm to construct MODEL-1 with 46 variables. After dimensionality reduction, we constructed MODEL-2. We calculated and compared the sensitivity and negative predictive value (NPV) of MODEL-1 and MODEL-2. Finally, we used the SHAP (SHapley Additive exPlanations) method to provide insights into the model’s outcome or prediction. MODEL-2 (AUROC: 0.822; 95% confidence interval [CI] 0.783–0.856), liked MODEL-1 (AUROC: 0.822; 95% CI 0.784–0.856), could well predict the risk of SBP in cirrhotic ascites patients. The 6 most influential predictive variables were total protein, C-reactive protein, prothrombin activity, cholinesterase, lymphocyte ratio and apolipoprotein A1. For binary classifier, the sensitivity and NPV of MODEL-1 were 0.894 and 0.885, respectively, while for MODEL-2 they were 0.927 and 0.904, respectively. We applied CatBoost algorithm to establish a practical and explainable prediction model for risk of SBP in cirrhotic patients with ascites. We also identified 6 important variables closely related to the occurrence of SBP.

FREQUENCY OF SYMPTOMATIC SPONTANEOUS BACTERIAL PERITONITIS AND ASSOCIATED CLINICAL PARAMETERS IN PATIENTS WITH LIVER CIRRHOSIS

Objective: To study association between spontaneous bacterial peritonitis and clinical symptoms in liver cirrhosis.&#x0D; Study Design: cross-sectional study.&#x0D; Place and Duration of Study: Combined Military Hospital Kharian, from Jul 2019 to Apr 2020.&#x0D; Methodology: A total of 122 patients of liver cirrhosis (irrespective of aetiology), presented with various clinical symptoms such as fever, pain abdomen and hepatic encephalopathy were randomly selected. Patients between 18-80 years of age, were included in the study. Asymptomatic patients, with ascites other than liver cirrhosis were excluded. Spontaneous Bacterial Peritonitis was defined as positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥250 cells/mm3 in ascitic fluid.&#x0D; Results: Of the 122 randomly selected patients, the mean age was 56.5 ± 20.2 years. Forty-Five (46.8%) were male and 67 (54.2%) patients were female. Chronic Hepatitis C was the commonest cause of liver cirrhosis (92%). The frequency of spontaneous bacterial peritonitis was 37.7%. Majority, (83%) of the culture positive ascitic isolate was Gram negative bacilli and E.coli (72%) being the commonest organism isolated. Severe ascites, high International Normalized Ratio (INR), hepatic encephalopathy, fever, low ascetic fluid protein count, high serum bilirubin and creatinine were considered to be independent predictor of Spontaneous Bacterial Peritonitis.&#x0D; Conclusion: Clinical symptoms of fever, hepatic encephalopathy, severe ascites, International Normalized ratio high and deranged renal profile was highly suggestive of Spontaneous Bacterial Peritonitis in cirrhotic patients.

Relationship between proton-pump inhibitor use and spontaneous bacterial peritonitis in cirrhotic patients with ascites

Objective The aim of this study was to assess the occurrence of spontaneous bacterial peritonitis in cirrhotic patients with ascites and is relationship to proton-pump inhibitor (PPI) use. Background Gastric acid plays an important role in resisting intestinal pathogens. Changes in gastric pH induced by antacids may damage the gastric protective barrier. Patients and methods This prospective cohort study was conducted on 100 patients of 18 years old or more, both sexes with liver cirrhosis and ascites. Patients were divided into two groups (50 patients in each); group (PPI use positive) with a history of PPIs use in the last 15 days at a dose of more than 20 mg and group (PPI use negative) without a history of PPI use. Results White blood cells in the blood and in the ascitic fluid showed significant increase in the PPI group than in the second group. Cultures of ascitic fluid were positive in 28 (56%) patients with PPI use, and 15 patients in the negative PPI use group and comparison showed significant increase in the positive PPI use group. The hazardous ratio of developing positive cultures in the PPI group is 1.687 times than the second group (95% confidence interval: 1.1–2.502). Conclusion The use of PPIs in cirrhotic patients who have ascites has a risk for developing spontaneous bacterial peritonitis; therefore, it is recommended to avoid their use in this category of patients.

Performance of Leukocyte Esterase Reagent Strips in the Detection of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Systematic Review and Meta-analysis

Spontaneous bacterial peritonitis (SBP) is a bacterial infection associated with a high mortality rate in cirrhotic patients. The gold standard for the detection of SBP is a manual cell count from ascitic fluid; however, alternative screening methods are under investigation. In particular, leukocyte esterase reagent strips (LERS) has been studied as an alternative method to detect SBP with a low cost and instant turnaround time. Therefore, this study aims to evaluate the performance of LERS in the detection of SBP. A literature search was performed for studies evaluating LERS for the detection of SBP on PubMed, Embase, Scopus, Cochrane, and clinical trial registries. Summary sensitivity, specificity, log diagnostic odds ratio (LDOR), and the area under the summary receiver operating curve (AUC) were calculated according to the respective manufacturer. In total, 31 studies were evaluated. The summary sensitivity of Aution Sticks, Combur, Multistix, Periscreen reagent strips was 0.962 (95% confidence interval [CI] 0.926, 0.998), 0.892 (95% CI 0.846, 0.938), 0.806 (95% CI 0.738, 0.874), and 0.939 (95% CI 0.900, 0.979), respectively. The summary specificity of Aution Sticks, Combur, Multistix, and Periscreen reagent strips was 0.940 (95% CI 0.904, 0.976), 0.922 (95% CI 0.874, 0.970), 0.974 (95% CI 0.962, 0.985), and 0.672 (95% CI 0.381, 0.963), respectively. LERS appears to have a notable overall performance for the detection of SBP. LERS appeared to be an acceptable alternative to diagnose SBP in facilities without ability to perform cell count. However, there were significant differences in performance between each manufacturer.

Proton pump inhibitors use and risk of developing spontaneous bacterial peritonitis in cirrhotic patients: A systematic review and meta-analysis

BackgroundSpontaneous bacterial peritonitis (SBP) is one of the most common infectious diseases in patients with cirrhosis and is associated with serious prognosis. A prevailing dogma posits that SBP is exacerbated by the frequent use of proton pump inhibitors (PPIs).AimsTo re-assess the association between PPIs use and SBP incidence with larger and better-quality data.MethodThe studies were identified by searching Proquest, Medline, and Embase for English language articles published between January 2008 and March 2020 using the following keywords alone or in combination: anti-ulcer agent, antacid, proton pump inhibitor, proton pumps, PPI, omeprazole, rabeprazole, lansoprazole, pantoprazole, esomeprazole, peritonitis, spontaneous bacterial peritonitis, SBP, ascites, cirrhosis, ascitic and cirrhotic. Three authors critically reviewed all of the studies retrieved and selected those judged to be the most relevant. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sub-group analyses were done to decrease the heterogeneity.ResultsA total of twenty-three studies: seven case–control, and sixteen cohorts, involving 10,386 patients were analyzed. The overall results showed a statistically significant association between SBP and PPIs use (pooled odds ratio (OR): 1.80, 95% CI of 1.41 to 2.31). Substantial heterogeneity was observed. On subgroup analysis involving cohort studies, the association was weaker (OR: 1.55 with 95% CI of 1.16 to 2.06 p < 0.00001) but still statistically significant and with high heterogeneity (Chi2p = 57.68; I2 = 74%). For case–control studies, the OR was 2.62 with a 95% CI of 1.94 to 3.54. The funnel plot was asymmetric and Egger’s test confirmed asymmetry suggesting publication bias (intercept = − 0.05, SE = 0.27, P = 0.850 two-tailed).ConclusionThis meta-analysis sheds light on the conflicting results raised by previous studies regarding the association of SBP with PPIs use. Our meta-analysis showed that there is a weak association, although statistically significant, between SBP and PPIs use. However, the magnitude of the possible association diminished when analysis focused on higher quality data that were more robust. Thus, this updated meta-analysis suggests judicious use of PPIs among cirrhotic patients with ascites.

Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Triggering Receptor Expressed on Myeloid Cells (TREM-1) as a Valid Marker

Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Triggering Receptor Expressed on Myeloid Cells (TREM-1) as a Valid Marker

Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites and Its Pattern in Aswan University Hospital

Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis. Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in patients of liver cirrhosis with ascites. Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January 2019 to December 2019. Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli. Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.

Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites and Its Pattern in Aswan University Hospital

Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis. Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in patients of liver cirrhosis with ascites. Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January 2019 to December 2019. Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli. Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.

Acute Life-Threatening Complications of Portal Hypertension: a Review of Pathophysiology, Incidence, Management, and Cost

Portal hypertension represents a dysfunctional hemodynamic alteration within the portal venous system, usually due to cirrhosis. These altered hemodynamics play a direct role in the development of acute, life-threatening variceal hemorrhage and mark an important pathophysiologic step in the development of other sudden and life-threatening complications such as type 1 hepatorenal syndrome and spontaneous bacterial peritonitis. Many life-saving interventions in these patients are aimed at reducing portal venous pressure. The contribution of portal hypertension to the development of variceal hemorrhage, type 1 hepatorenal syndrome (known also by the name HRS-AKI), and spontaneous bacterial peritonitis in cirrhotic patients is discussed. This article reviews the pathophysiology and incidence of life-threatening complications of cirrhotic portal hypertension, with a discussion of management options and treatment costs.

Comparative study between spontaneous fungal peritonitis (SFP) and spontaneous bacterial peritonitis (SBP) in patients with end stage liver disease (ESLD)

Background: Bacterial infections in end stage liver disease are common and associated with increased mortality. Although extensive research has elucidated the impact of bacterial infections as the major precipitating event leads to increased frequency of liver-related complications and mortality in these patients. Objective: Evaluating the clinical and laboratory characters, risk factors, and outcome of fungal and bacterial peritonitis in cirrhotic patients with end stage liver disease (ESLD). Patients and Methods: This cross sctional study enrolled 60 patients with liver cirrhosis and ascites. Fifty patients were culture-positive spontaneous peritonitis, including 12 with spontaneous fungal peritonitis (SFP), and 38 culture-positive spontaneous bacterial peritonitis (SBP), and 10 patients without clinical or laboratory evidence of peritonitis as a control group, during the study period, between 1st February 2018 and 30th May 2019. We compared the clinical, laboratory findings, Child–Pugh scores, model for end stage liver disease (MELD) score, risk factors, and mortality rates between patients with spontaneous peritonitis associated with fungal culture-positive ascites, and those with spontaneous peritonitis associated with bacterial culture-positive ascites. Results: Patients of the current study were critically ill. The mean duration of ESLD in the studied patients was 4.75 ± 1.8 year, 57 patients (95.0%) were Child score C, and 3 patients (5%) were Child score B. The mean MELD score was 23.32 ± 5.49. All patients with evidence of peritonitis were Child C, and mean MELD scores were 22.6 ±5.7 and 26.1±4.5 in SBP and SFP groups respectively. Jaundice, GI bleeding and hepatic encephalopathy were significantly for clinical presentation and predictors of mortality in SFP group compared to SBP and control group. Lower levels of hemoglobin (Hb), S. albumin and platelets count and increased level of total leukocytic count (TLC), international normalized ratio (INR), and bilirubin were significantly higher in SFP group compared to SBP and control group. Duration of ESLD and hospital admission was significant in SFP compared to SBP and control group. HCC was evident in SFP group (66.7%) that was highly significant in comparison to SBP (28.9%), and control group (20%). Overall mortality rate among the studied groups was 45%, the mortality rate was significantly increased in SFP group (75%) compared to SBP (42.1%), and control group (20%).The mean MELD score significantly increased in non-survival group compared to survival group . The duration of ESLD significantly increased in non-survival group compared to survival group. Conclusion: Prolonged and severe underlying liver disease with a high Child- Pugh or MELD score, renal impairment, HCC, and onset of severe sepsis have been reported as risk factors in increased mortality in patients with SFP than in SBP. In SFP, mortality was associated not only with the severity of the underlying liver disease, but also with delay in diagnosis and initiation of antifungal therapy.