FREQUENCY OF ASYMPTOMATIC SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS OF LIVER CIRRHOSIS WITH ASCITES

Bacterial Peritonitis

Abstract

Objective: To determine the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites.
Study Design: Descriptive study.
Place and Duration of Study: The study was conducted at indoor and outpatient departments of Medicine, Military Hospital, Rawalpindi, Pakistan from 29th February 2008 to 28th August 2008.
Subject and Methods: One hundred and ninety five patients of liver cirrhosis with ascites were selected. To standardize the study; patients of both genders over 18 years of age, diagnosed with liver cirrhosis and ascites were included in the study after obtaining their informed consent. Patients with abdominal tenderness and fever, hepatic encephalopathy, intra-abdominal surgically treatable cause, with any co-morbid disease (hypertension and diabetes mellitus) or refusing to give consent were excluded from the study. Strict inclusion/exclusion criteria were observed to control the confounding variables. Diagnosis of spontaneous bacterial peritonitis was based on increased ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 250 cells / mm3) and/or positive bacterial culture.
Results: Out of 195 patients, 10 patients (5%) had neutrocytic ascites (absolute neutrophil count ≥ 250 cell/mm3). Out of these 195 patients, three patients (1.5%) were found to have positive ascitic fluid culture.
Conclusion: In our study the frequency of asymptomatic spontaneous bacterial peritonitis in patients of liver cirrhosis with ascites turned out to be 5% which is low. Therefore, analysis of ascitic fluid through diagnostic paracentesis should be reserved for inpatient or outpatient with clinically apparent new onset ascities or in cirrhotic patients with ascities whose general condition deteriorates.