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.
