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Category: Volume 05 Issue 12 December 2017
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Title: A Profile of Spontaneous Bacterial Peritonitis and Its Variants in Cases of Liver Cirrhosis

Authors: Dr Rohan Yewale, Dr Jeyhan Dhabhar, Dr Jaishree Ghanekar

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.04

Abstract

Background: Spontaneous bacterial peritonitis is a complication of decompensated liver cirrhosis1 notorious for its high recurrence rates and is frequently associated with short term as well as long term mortality in the affected patients.

Objective: To analyse the incidence, clinical and bacteriological profile of patients with spontaneous bacterial peritonitis or its variants such as culture negative neutrocytic ascites and bacterascites in cases of liver cirrhosis. Patients with SBP or its variants were compared to patients with Non SBP Ascites in order to assess the predictive factors for the development of SBP or its variants and thereby relate the in hospital mortality in these patients with various possible parameters.

Methods: The present study was a prospective, cross sectional, comparative study conducted among 60 patients with ascites due to liver cirrhosis fulfilling the proposed inclusion and exclusion criteria, admitted at MGM Medical College and Hospital, Navi Mumbai, between November 2014 and November 2016. Ascitic fluid routine and culture analysis with antibiotic sensitivity testing along with other routine blood and urine investigations were performed at an NABL (National Accreditation Board for Testing and Calibration Laboratories) certified laboratory at MGM Medical College and Hospital, Navi Mumbai.

Results: Our study demonstrated an in hospital mortality of 21.67% amongst all patients and 20% amongst patients with SBP or its variants similar to the study by Nakul Kadam et al (17%). Our study also revealed that variables such as Child Pugh Grade C, MELD Na score > 30, anemia, leukocytosis, coagulopathy or deranged PT INR, hyperbilirubinemia, hyponatremia, AKI, hepatic encephalopathy, refractory Ascites, hepatorenal Syndrome and absence of albumin transfusion during hospitalization were significantly associated with mortality.

Conclusion: Spontaneous bacterial peritonitis is a frequent and unprecedentedly mortal complication that is often undiagnosed in patients of liver cirrhosis with ascites unless there is a high degree of suspicion. Our study corroborates previous postulates on this subject with regard to predictive factors for development of SBP & associated mortality. However, being a small sample study, the results cannot be subjected to a large scale population.

Keywords: Ascites, Hepatic encephalopathy, Hepatorenal syndrome, Liver cirrhosis, Spontaneous bacterial peritonitis.

References

  1. Jan Lata,Oldřich Stiburek, and Marcela Kopacova. Spontaneous bacterial peritonitis: A Severe complication of liver cirrhosis. World J Gastroenterol. 2009 Nov 28; 5(44) 5505–5510.
  2. Sherlock S, Dooley J. Spontaneous bacterial peritonitis. In: Sherlock and Dooley's Diseases of the liver and biliary system. 11th ed. Oxford: Blackwell, 2002132–134.134
  3. Bacon Bruce R. 17th Edition. 2008. Cirrhosis and Its complications. Harrison’s Principles of Internal Medicine; p. 1979.
  4. Conn HO.In: Diseases of the liver. 4th edition. Vol. 833. Philadelphia: J.B. Lippincott Company; 1975. Cirrhosis. Edited by Schiff L.
  5. MNavasa, J Rodes. Bacterial infections in cirrhosis. Liver Int. 2004; 24:277–80.
  6. J Llach, A Rimola, M Navasa, P Ginès, JM Salmerón, A Ginès, et al. Incidence and Predictive factors of first episode of spontaneous bacterial peritonitis in cirrhosis with Ascites: relevance of ascitic fluid protein concentration. Hepato-logy. 1992; 16:724–27.
  7. R Wiest, A Krag, A Gerbes Spontaneous bacterial peritonitis: recent guidelines and Beyond; Gut 2012; 61:297-310 Published Online First: 6 December 2011.
  8. Koulaouzidis A, Bhat S, Karagiannidis A, Tan WC, Linaker BD. Spontaneous bacterial Peritonitis; Postgrad Med J. 2007 Jun; 83(980):379-83. 3
  9. G Pinzallo, RG Simonetti, ACraxi, SO Piazza, C Spano, l Pagliaro. Spontaneous Bacterial peritonitis: A prospective investigation in predominantly non-alcoholic cirrhotic Patients. Hepatology. 1983; 3:545–49.
  10. AP Jain, LS Chandra, S Gupta, et al. Spontaneous Bacterial Peritonitis in liver cirrhosis with ascites. J Assoc physicians India. 1999;47(6):619–21.
  11. Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS,Sleisenger MH, editors.Sleisenger and Fordran’s Gastrointestinal and Liver Disease, 8th Philadelphia, PA: Saunders; 2006. pp. 1935–1964.
  12. Runyon B A. Paracentesis of ascitic fluid: a safe procedure. Arch Intern Med 19861462259–2261.2261.
  13. Song J Y, Jung S J, Park C W. et alPrognostic significance of infection acquisition sitesin spontaneous bacterial peritonitis: nosocomial vs. community acquired. J Korean Med Sci 200621666–671.67.
  14. Grabau C M, Crago S F, Hoff LK et al. Performance standards for therapeutic abdominal paracentesis. Hepatology  200440484–488.
  15. Lin C H, Chen S C, Ko P C. Pre‐procedure coagulation tests are un‐necessary before abdominal paracentesis in emergency departments. Hepatology 200541402–403.403.

Corresponding Author

Dr Jeyhan Dhabhar

Resident, MGM Medical College & Hospital, Navi Mumbai