Prevalence Of Spontaneous Bacterial Peritonitis Research Articles

A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites at a Tertiary Care Hospital in North India: Prevalence, Clinical, and Microbiological Profile

Background and Objectives: In patients with chronic liver disease and ascites, spontaneous bacterial peritonitis (SBP) is a common complication. This can progress gradually and subtly or go undiagnosed until signs start to show. Early diagnosis is essential for effective treatment and the prevention of subsequent episodes because the mortality rate following a single episode varies from 20% to 40%. The goal was to study the incidence, clinical profile, and microbiological characteristics of SBP and its variants in people with liver cirrhosis and ascites. Materials and Methods: This observational study was done on 104 cirrhotic patients with ascites admitted at a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done aseptically and immediately sent for ascitic fluid cytology, biochemistry, and culture. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques. Results: Out of a total of 104 cirrhotic patients, 28 (26.9%) were diagnosed with SBP. Alcohol was the most common etiological factor, followed by hepatitis C infection. Among the SBP patients, the most common presentation was culture-negative neutrocytic ascites (71.4%), followed by classical SBP (17.8%), then mono bacterial non neutrocytic bacterascites MNB (10.7%). Among the symptoms, the most common was abdominal distension, followed by icterus, pedal edema, and abdominal pain. Majority of the patients belonged to Child–Pugh’s Grade C. Of 28 cases of SBP, 8 were culture positive. Gram-negative isolates were predominant (75%) and Escherichia coli were the most common isolate. Interpretation and Conclusion: The prevalence of SBP in cirrhotic patients was 26.9%, and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotics is common.

Spontaneous Bacterial Peritonitis among Chronic Liver Disease Patients with Ascites Admitted to the Department of Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Chronic liver disease is a common problem worldwide. Spontaneous bacterial peritonitis is a dreaded complication and has high in-hospital mortality. Few studies have been done about the prevalence of spontaneous bacterial peritonitis and associated clinical and biochemical features in a hospital-based population. The aim of this study was to find out the prevalence of spontaneous bacterial peritonitis in chronic liver disease patients with ascites admitted to Department of Medicine in a tertiary care centre. A descriptive cross-sectional study was done among patients with chronic liver disease with ascites admitted to the Department of Medicine of a tertiary care centre between 18 March 2021 to 28 February 2022 after receiving ethical approval from the Institutional Review Committee (Reference number: PMM2103161493). Convenience sampling method was used. Diagnostic paracentesis was done in every such patient. Point estimate and 95% Confidence Interval were calculated. Among 157 patients, the prevalence of spontaneous bacterial peritonitis was 46 (29.29%) (22.17-36.41, 95% Confidence Interval). The most common presenting symptom was pain abdomen seen in 29 (63.04%). The prevalence of spontaneous bacterial peritonitis in chronic liver disease patients with ascites was similar to studies done in similar settings. Clinicians should be aware that it can present with or without abdominal pain. ascites; liver diseases; peritonitis; prevalence.

Prevalence of Spontaneous Bacterial Peritonitis (SBP) in Hepatitis B (HBV), and Hepatitis C (HCV) Liver Cirrhosis: A Systematic Review and Meta-Analysis.

Spontaneous bacterial peritonitis (SBP) is a common infection in liver cirrhosis. This systematic review and meta-analysis provide detailed information on the prevalence of SBP among hepatitis B virus (HBV) and hepatitis C virus (HCV)-related liver cirrhosis globally. A systematic search for articles describing the prevalence of SBP in HBV and HCV-related cirrhosis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Our search returned ten (10) eligible articles involving 1713 viral cirrhosis cases representing eight (8) countries. A meta-analysis was performed on our eligible studies using the random effect model. A protocol was registered with PROSPERO (CRD42022321790). The pooled prevalence of SBP in HBV-associated cirrhosis had the highest estimate [8.0% (95% CI, 2.7-21.0%; I2 = 96.13%; p < 0.001)], followed by SBP in HCV-associated liver cirrhosis [4.0% (95% CI, 1.3%-11.5%; I2 = 88.99%; p < 0.001)]. China (61.8%, CI: 57.1-66.3%), the USA (50.0%, CI: 34.6-65.4%), and Holland (31.1%, CI: 21.6-42.5%) had the highest estimate for SBP in HBV associated liver cirrhosis, SBP in HCV associated liver cirrhosis and SBP in HBV + HCV associated liver cirrhosis respectively. There was a significant difference in the prevalence of SBP in viral hepatitis-associated liver cirrhosis with the year of sampling and method of SBP detection at P < 0.001. There was an increase in SBP incidence at the beginning of 2016 across the liver cirrhosis in this study. The findings of this review revealed a rise in the incidence of SBP in viral hepatitis over the last decade. The latter indicates a possible future rise in the global prevalence of SBP among HBV and HCV-related liver cirrhosis.

Cirrhotic patients on proton pump inhibitors are at a twofold risk of spontaneous bacterial peritonitis independently of gastrointestinal bleeding: a population-based retrospective study.

Recent findings suggest that cirrhotic patients on proton pump inhibitors (PPIs) are at a higher risk for developing spontaneous bacterial peritonitis (SBP) than non-PPI users. We aimed to identify whether PPI use is an independent risk factor for the development of SBP among cirrhotic patients in the United States (US). We enrolled a retrospective cohort using a validated multicenter database. Patients with a SNOMED-CT diagnosis of "cirrhosis" between 1999 and 2022 were identified. All patients below 18 years of age were excluded. We calculated the prevalence of individuals using PPIs in the total US population and in cirrhotic patients from 1999 to date, and the incidence of SBP in the past year. Finally, we constructed a multivariate regression model, controlling for multiple covariates. The final analysis included 377,420 patients. The 20-year-period prevalence of SBP in patients with cirrhosis was 3.54% and the prevalence of patients using PPIs in the US population was 12,000 per 100,000 people (12.00%). The 1-year incidence of SBP in cirrhotic patients using PPIs was 2500 per 100,000 people. After accounting for confounders, the risk of SBP was higher among males, patients with a diagnosis of gastrointestinal bleeding, and those using β-blockers and PPIs. To date, this is the largest cohort used to examine the prevalence of SBP among cirrhotic patients in the US. PPI use and hepatic encephalopathy offered the highest risk for the development of SBP, independently of gastrointestinal bleeding. Focusing on judicious PPI use should be encouraged among cirrhotic patients.

Prevalence of Spontaneous Bacterial Peritonitis in Patients Presenting with Upper Gastrointestinal Bleeding in Decompensated Chronic Liver Disease Patients

Background: Over the last several decades, chronic liver disease incidence has increased globally. One of the most common complications of cirrhosis is spontaneous bacterial peritonitis. Objective: To assess the prevalence of spontaneous bacterial peritonitis in patients presenting with upper gastrointestinal bleeding in decompensated chronic liver disease patients Methodology: The current study was cross sectional carried out at the Gastroenterology department, Qazi Hussain Ahmad Medical Complex, Nowshera. The duration of study was one year from August 2021 to August 2022. All the data like name, age gender and other information related to medical history were recorded on a predesigned proforma. All the analysis of collected data was done by employing IBM SPSS version 24. . Results: In the current study, totally 100 patients were enrolled. There were 60 (60%) male participants and 40 (40%) patients were female in our study. The overall prevalence of spontaneous bacterial peritonitis in patients presenting with upper gastrointestinal bleeding in decompensated chronic liver disease was 29 (29%). Conclusion: Our study concludes that the prevalence of spontaneous bacterial peritonitis in patients presenting with upper gastrointestinal bleeding in decompensated chronic liver disease patients is high. Spontaneous bacterial peritonitis frequency is also high in patients with Child-Pugh Class C as compared to Child-Pugh Class B. Keywords: Decompensated chronic liver disease; spontaneous bacterial peritonitis; Prevalence

Prevalence of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis with Ascites

Bacterial infections are considered a significant challenge in patients with cirrhosis. They account for 25%–46% of hospitalizations in patients with cirrhosis due to significant decompensation processes and are associated with substantial morbidity and mortality. Objective: To determine the prevalence of SBP in patients with liver cirrhosis and ascites. Methods: According to the inclusion criteria, 199 patients with cirrhosis and ascites were included in the study, regardless of the cause of cirrhosis (alcohol, HCV, HBV, autoimmune, cryptogenic, etc.). SBP frequency in cirrhotic with ascites was documented using a proforma. All data was entered into a proforma template. All patients were treated with respect to evaluate the prevalence of SBP in cirrhosis with ascites patients. The study was conducted at the Department of Medicine at Gujranwala Medical College-District Headquarters Hospital in Gujranwala. Total duration of study was six months. Results: In terms of patient age distribution, 49 patients (24.6%) were between the ages of 30 and 45, 150 patients (75.4%) were between the ages of 46 and 60. The cohort's patients had an average age of 51.21± 6.61. 42.7% of the population (n = 85) was female, while 57.3% (n = 114) was male. SBP frequency was 32.2% in cirrhosis with ascites individuals. Conclusions: We concluded that 32.2% of participants with cirrhosis with ascites also had SBP. The mortality rate in these patients will be decreased by early diagnosis and treatment. Any patient with cirrhosis and ascites should have SBP ruled out.

Role of Dipstick (Leucocyte Esterase Reagent Strips) in the Rapid Bedside Diagnosis of Spontaneous Bacterial Peritonitis

Objectives: To evaluate the dipstick in the rapid bedside diagnosis of spontaneous bacterial peritonitis (SBP) and avoid delay in initiation of antibiotic therapy and evaluate the prevalence of SBP by a conventional method. Methods: A prospective analysis was done on inpatients and OPD patients with cirrhotic ascites at Jaipur Golden Hospital Delhi, India. The study included 110 consecutive patients with cirrhotic ascites. The patients were divided into 2 groups those with the polymorph nuclear leucocytes (PMNs) >250/mm3 on cell count (positive result) and those with PMNs <250/mm3 (Negative results) and were then compared to the dipstick results. The results were used to find the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the rapid dipstick method for the diagnosis of SBP. In addition, the data was used to calculate the prevalence of SBP in our hospital. Results: A total number of 110 patients with cirrhotic ascites were studied who were presented to the Jaipur Golden Hospital, New Delhi, India with the complaint of abdominal distension. A total of 20 patients were diagnosed with SBP by the manual cell count method which is considered a gold standard for the diagnosis of SBP, and 90 patients were diagnosed as non-SBP. We re-diagnosed these 20 patients with SBP with a dipstick method, the dipstick method showed a positive result for 18 patients (90%) and a negative result for 2 patients (10%). Conclusion: In the SBP group, the dipstick showed 18 true positives and 2 false negatives. In the non-SBP group of 90 patients, the dipstick method showed negative results in all the patients with no positive results. Thus, the dipstick showed 100% true negatives with 0% false positives. The prevalence of SBP in patients with cirrhotic ascites in a hospital was found at 18.2%.

Spontaneous Bacterial Peritonitis among Cirrhotic Patients: Prevalence, Clinical Characteristics, and Outcomes.

(1) Background: Spontaneous bacterial peritonitis (SBP) is a feared complication of liver cirrhosis. We investigated the prevalence of SBP, positive ascitic fluid cultures, and risk factors for mortality. (2) Methods: A retrospective analysis of all patients with cirrhosis hospitalized or in follow-up in a single center between 1996 and 2020. The clinical data, long-term complications, and mortality of SBP patients were compared with those of non-SBP patients. Ascitic fluid positive culture was compared with those without growth. (3) Results: We included 1035 cirrhotic patients, of which 173 (16.7%) developed SBP. Ascitic fluid culture growth was found in 47.4% of the SBP cases, with Escherichia coli bacteria detected in 38%, 24.4% grew ESBL-producing bacteria, and 14.5% displayed multidrug resistance. In a Cox regression model, SBP, male sex, prolonged INR at diagnosis, and hepatocellular carcinoma were found to be risk factors for mortality in cirrhotic patients. The long-term all-cause mortality was 60% in non-SBP and 90% in SBP patients. (4) Conclusions: Only a minority of cirrhotic patients developed SBP, 47.4% of which had positive ascitic fluid cultures with high antibiotic resistance. Growth of ESBL and multidrug resistant organisms is becoming more frequent in the clinical setting, reaching SBP mortality of 90%.

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

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.

Prevalence of spontaneous bacterial peritonitis in patients with hepatic cirrhosis in the military central hospital

Prevalence of spontaneous bacterial peritonitis in patients with hepatic cirrhosis in the military central hospital

Low Prevalence of Spontaneous Bacterial Peritonitis in Ambulatory Asymptomatic Cirrhotic Patients: Consequences in Patients’ Care

The literature on the prevalence of spontaneous bacterial peritonitis (SBP) in cirrhotic outpatients who visited the hospital for therapeutic abdominal paracentesis was reviewed in order to assess the usefulness of urinary strips in this setting. The authors reviewed the studies published as peer-reviewed articles on the prevalence of SBP in ambulatory outpatients who visited the hospital for therapeutic paracentesis. Five such studies were available in the literature. It was found that the prevalence of SBP was in the range of 0%–3.5%. In regard to the use of reagent strips, Multistix8 SG is not useful in this setting, while the PeriscreenTM strip is a consistent screening tool for the rapid detection of SBP, particularly in the outpatients’ setting (negative predictive value: 99.4%–100%). In asymptomatic cirrhotic outpatients undergoing a large volume of paracentesis with low risks of infection, the prevalence of spontaneous bacterial peritonitis is low. In this setting, a systematic analysis of ascitic fluid could be avoided. The use of reagent strips may serve as an alternative. Among the reagent strips tested so far, the PeriscreenTM strip has exhibited the highest diagnostic performance with a high negative predictive value.

Assessment of serum 25-hydroxy vitamin D in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP)

Abstract Background Vitamin D has pleotropic effect including the immune function, it increases innate immunity and modifies lymphocyte activation. The risk for bacterial infections is increased in cirrhotic patients due to low levels of vitamin D, so its deficiency may be linked with the prevalence of SBP in cirrhotic patients Aim of the work To assess the 25-OH vitamin D serum level in cirrhotic patients and it’s relation to spontaneous bacterial peritonitis. Patient & Methods The current study included 90 patients divided into three groups; group one; patients with compensated liver cirrhosis, group two; patients with decompensated liver cirrhosis without SBP and group three; patients who had decompensated cirrhosis with SBP. The following laboratory work up was done: Serum 25-OH vitamin D level, liver functions test, kidney functions test, complete blood count, and ascitic neutrophil count. Results We report a highly significant difference between the studied groups as regards 25-OH vitamin D level, being lowest in group three. A negative correlation between markers of severe cirrhosis and vitamin D concentrations was found in our cirrhotic patients. Conclusion Vitamin D deficiency is associated with increased incidence of infections in cirrhotic patients including spontaneous bacterial peritonitis, suggesting that Vitamin D supplementation may be useful in these patients.

Assessment of serum 25-hydroxy vitamin D in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP)

Abstract Background Vitamin D has pleotropic effect including the immune function, it increases innate immunity and modifies lymphocyte activation. The risk for bacterial infections is increased in cirrhotic patients due to low levels of vitamin D, so its deficiency may be linked with the prevalence of SBP in cirrhotic patients Aim of the work To assess the 25-OH vitamin D serum level in cirrhotic patients and it’s relation to spontaneous bacterial peritonitis. Patient & Methods The current study included 90 patients divided into three groups; group one; patients with compensated liver cirrhosis, group two; patients with decompensated liver cirrhosis without SBP and group three; patients who had decompensated cirrhosis with SBP. The following laboratory work up was done: Serum 25-OH vitamin D level, liver functions test, kidney functions test, complete blood count, and ascitic neutrophil count. Results We report a highly significant difference between the studied groups as regards 25-OH vitamin D level, being lowest in group three. A negative correlation between markers of severe cirrhosis and vitamin D concentrations was found in our cirrhotic patients. Conclusion Vitamin D deficiency is associated with increased incidence of infections in cirrhotic patients including spontaneous bacterial peritonitis, suggesting that Vitamin D supplementation may be useful in these patients.

Microbiological profile of pathogens in spontaneous bacterial peritonitis secondary to liver cirrhosis: a retrospective study.

Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid without an obvious source. The prevalence of SBP in patients with cirrhosis is in the range of 10%-30%. With increasing use of antibiotics, there is a gradual shift in the causative flora of SBP from Gram-negative bacteria to Gram-positive and, more importantly, to drug-resistant bacteria. The aim of this retrospective study on 721 cases was to identify the prevalence of various organisms causing SBP along with their drug sensitivity and resistance patterns. A prevalence of 38.2% culture positivity was observed in our South Indian population. Escherichia coli was the most common pathogen isolated. Third-generation cephalosporins showed high rates of resistance, but a susceptibility of 74.5% to amikacin was found. Nonetheless, 42% of culture-positive isolates exhibited multidrug resistance, the highest rates being seen with Enterococcus faecium (64.2%) and Acinetobacter baumannii (71.4%).

Spontaneous Bacterial Peritonitis and Short-Term Prognosis in a Group of Decompensated Cirrhotic Patients in Yaounde: A Cross-Sectional Study

Introduction: Spontaneous bacterial peritonitis (SBP) is among the most common infections in cirrhotic patients. Data on SBP are rare in Cameroon. This prompted us to carry out this study on patients with decompensated cirrhosis of the liver in Yaounde University Hospital Centre (YUHC). Methods: We carried out a cross-sectional study from December 2015 to June 2016 in three units of YUHC. All patients with decompensated liver cirrhosis were included. Our sampling was consecutive. Diagnosis of cirrhosis was performed, based on clinical, biological and ultrasound criteria. A neutrophil count greater than 250 cell/mm3 in ascites fluid defined an SBP. Data on socio-demography, clinical presentation, and outcomes were collected. Results: We included 34 decompensated cirrhotic patients (15 males). Patients mean age was 57.5 ± 2 years (SBP positive: 48.7 ± 21.3 versus without SBP: 59.8 ± 19.5, p = 0.22). SBP diagnosis was made in 6 (17.7%) patients. Compared to patients with decompensated liver cirrhosis and without SBP, positive SBP patients had a higher pulse rate (p = 0.002) and respiratory rate (p = 0.02). The patients with SBP were more likely to present these other clinical features: pulse rate >100 (RR: 4.2, [95% CI: 0.7 - 27.7]; p = 0.02), presence of jaundice (RR: 3.4, [95% CI: 0.6 - 21.1]; p = 0.09), being from female gender (RR: 3.2, [95% CI: 0.5 - 19.9]; p = 0.11), advanced liver disease (Child C class) (RR: 2.4, [95% CI: 0.4 - 14.5], p = 0.66), low-plasma albumin (less than 20 g/L) (RR: 1.7, [95% CI: 0.8 - 3.9], p = 0.08), respiratory rate > 30 (RR: 1.6, [95% CI: 0.6 - 3.3], p = 0.05) and fever/hypothermia (RR: 1.5, [95% CI: 0.6 - 3.4]; p = 0.22). Evolution after a 72-hours antibiotherapy was stationary in four cases and unfavorable in two patients, resulting in death. Conclusion: SBP prevalence was 17.7%. SBP patients were younger, from female sex, tachycardia and polypnea, presenting with fever/hypothermia and signs of advanced liver disease than non-SBP patients. Improvement of our technical platform will be useful to determine the cause of cirrhosis and identify the different germs responsible for SBP.

1005 Worse Functional Status at Time of Liver Transplant Waitlist Registration Is Associated With Significantly Greater Prevalence of Hepatic Encephalopathy, Ascites, and Spontaneous Bacterial Peritonitis

INTRODUCTION: Poor functional status (FS) is associated higher liver transplant (LT) waitlist mortality. Whether this higher risk of death is mediated by higher prevalence of cirrhosis complications is not clear. We aim to evaluate the impact of FS at time LT waitlist registration on odds of hepatic encephalopathy (HE), ascites, and spontaneous bacterial peritonitis (SBP) among adults listed for LT. METHODS: Using 2003-2018 United Network for Organ Sharing LT data, we retrospectively evaluated the impact of FS on prevalence of HE, ascites, and SBP among U.S. adults listed for LT using Karnofsky Performance Status categories (KPS-1: FS 80-100%, KPS-2: 60-70%, KPS-3: 40-50%, KPS-4: 10-30%). We further stratified patients by etiology: hepatitis C (HCV), nonalcoholic steatohepatitis (NASH), alcoholic liver disease (ALD), and combined HCV/ALD. Comparisons of HE, ascites, and SBP prevalence between groups utilized chi-squared methods and adjusted multivariate logistic regression. RESULTS: Among 101,249 adults listed for LT (70.1% male, 72.7% non-Hispanic white, 20.3% HCC) 38.2% were KPS-1, 35.6% KPS-2, 14.5% KPS-3, and 11.7% KPS-4. Patients with worse FS were more likely to have HE, ascites, and SBP at time of waitlist registration (HE: 82% (KPS-4) vs. 52% (KPS-1); ascites: 68% (KPS-1) vs. 93% (KPS-4); SBP: 4% (KPS-1) vs. 17% (KPS-4), P < 0.001 for all)) (Figure 1). On multivariate regression, worse FS was associated with greater odds of HE (KPS-4 vs. KPS-1: OR 1.62, 95% CI 1.52-1.73, P < 0.01), ascites (KPS-4 vs. KPS-1: OR 1.41, 95% CI 1.29-1.54, P < 0.01), and SBP (KPS-4 vs. KPS-1: 2.12, 95% CI 1.93-2.33, P < 0.01). Compared to HCV patients, greater odds of HE and ascites were observed in NASH (ascites, OR 1.32, 95% CI 1.25-1.39, P < 0.01), ALD (ascites, OR 1.58, 95% CI 1.52-1.65, P < 0.01), and HCV/ALD (ascites, OR 1.40, 95% CI 1.32-1.49, P < 0.01). While ALD and HCV/ALD patients also had greater odds of SBP vs. HCV, NASH patients had lower odds of SBP (OR 0.92, 95% CI 0.85-0.99, P = 0.03). When stratified by etiology, similar trends were observed, with worse FS strongly associated with greater odds of HE, ascites, and SBP across all etiologies. CONCLUSION: Worse FS is associated with higher odds of cirrhosis complications including ascites, HE, and SBP, which was observed across all liver disease etiologies. Disease-specific comparisons showed higher odds of ascites, HE, and SBP in HCV vs. other etiologies, with the exception of lower odds of SBP in NASH patients vs. HCV.

Spontaneous bacterial peritonitis among adult patients with ascites attending Korle-Bu Teaching Hospital.

Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of ascites, mostly in patients with cirrhotic ascites and children with nephrotic syndrome. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. It is therefore important to determine the prevalence of SBP among in-patients with ascites attending our facility and to determine the clinical characteristics associated with SBP among these patients. A cross-sectional study was conducted involving 140 patients with ascites irrespective of the underlying cause from 25th March 2016 to 25th November 2016. Demographic information and clinical data were collected using a standardized questionnaire. Ascitic fluid culture, the gold standard for SBP diagnosis and ascitic fluid cell count was done. Positive ascitic fluid culture and/ or ascitic polymorpho nuclear leukocyte ≥250cells/mm3 were diagnostic for SBP. Of the 140 patients with ascites the mean age was 44.7±13.2 years. There were seventy six (76) male and sixty four (64) female patients. The prevalence of SBP was 21.43% (30/140). Majority, (41.7%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. History of jaundice, low arterial blood pressure on admission and encephalopathy were found to be independent predictors of SBP. SBP is common among patients with ascites admitted at the Korle-Bu Teaching Hospital. Jaundice, encephalopathy and low blood pressure are highly suggestive of SBP and diagnostic paracentesis should be done immediately on admission to confirm the diagnosis. None.

Compartmentalization of Immune Response and Microbial Translocation in Decompensated Cirrhosis.

Background: Acquired dysfunctional immunity in cirrhosis predisposes patients to frequent bacterial infections, especially spontaneous bacterial peritonitis (SBP), leading to systemic inflammation that is associated with poor outcome. But systemic inflammation can also be found in the absence of a confirmed infection. Detection of bacterial DNA has been investigated as a marker of SBP and as a predictor of prognosis. Data is, however, contradictory. Here we investigated whether levels of IL-6 and IL-8 putatively produced by myeloid cells in ascites are associated with systemic inflammation and whether inflammation depends on the presence of specific bacterial DNA.Methods and Materials: We enrolled 33 patients with decompensated liver cirrhosis from whom we collected paired samples of blood and ascites. IL-6 and IL-8 were measured in serum samples of all patients using ELISA. In a subset of 10 representative patients, bacterial DNA was extracted from ascites and whole blood, followed by 16S rRNA gene amplicon sequencing.Results: There were significantly higher levels of IL-6 in ascites fluid compared to blood samples in all patients. Interestingly, IL-6 levels in blood correlated tightly with disease severity and surrogates of systemic inflammation, while IL-6 levels in ascites did not. Moreover, patients with higher blood CRP levels showed greater SBP prevalence compared to patients with lower levels, despite similar positive culture results. Bacterial richness was also significantly higher in ascites compared to the corresponding patient blood. We identified differences in microbial composition and diversity between ascites and blood, but no tight relationship with surrogates of systemic inflammation could be observed.Discussion: In decompensated cirrhosis, markers of systemic inflammation and microbiota composition seem to be dysregulated in ascites and blood. While a relationship between systemic inflammation and microbiota composition seems to exist in blood, this is not the case for ascites in our hands. These data may suggest compartmentalization of the immune response and interaction of the latter with the microbiota especially in the blood compartment.