In a randomized controlled trial, addition of simvastatin to standard therapy did not reduce rebleeding, but was associated with a survival benefit for patients with Child-Pugh class A or B cirrhosis. Survival was not the primary end point of the study, so these results require validation. The incidence of rhabdomyolysis in patients receiving 40 mg/d simvastatin was higher than expected. European Clinical Trial Database ID: EUDRACT 2009-016500-24; ClinicalTrials.gov ID: NCT01095185.

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p-TIPS must be the treatment of choice in CP-C patients with AVB. Due to the strong benefit in preventing further bleeding and ascites, p-TIPS could be a good treatment strategy for CP-B+AB patients. This article is protected by copyright. All rights reserved.

Portal thrombosis is associated with greater operative complexity and rethrombosis, but has no influence on overall morbidity and mortality.

We studied the use of reagent strips for diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. A reagent strip for leukocyte esterase designed for the testing of urine with a colorimetric 5-grade scale (0 to 4) was used to evaluate ascitic fluid in 228 nonselected paracentesis performed in 128 cirrhotic patients. We diagnosed 52 SBP and 5 secondary bacterial peritonitis by means of polymorphonuclear cell count and classical criteria. When we considered positive a reagent strip result of 3 or 4, sensitivity was 89% (51 of 57), specificity was 99% (170 of 171), and positive predictive value was 98%. When we considered positive a reagent strip result of 2 or more, sensitivity was 96% (55 of 57), specificity was 89% (152 of 171), and negative predictive value was 99%. In conclusion, the use of reagent strips is a rapid, easy to use, and inexpensive tool for diagnosis of ascitic fluid infection. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP. (HEPATOLOGY 2003;37: 893-896.)See Editorial on Page 745 S pontaneous bacterial peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. The prevalence of SBP in unselected patients admitted to the hospital ranges between 10% and 30%. 1 Although infection resolution is high with antibiotic therapy, in-hospital mortality is still over 20%, 2 mainly secondary to hepato-renal syndrome.Sensitive methods of ascitic fluid cultures reach 80% positivity in patients with SBP in the context of clinical trials, 3,4 but, in clinical practice, ascites culture is negative in more than 60% of patients with SBP, 5 and culture results are delayed for several days; thus, diagnosis of SBP must be based on the polymorphonuclear (PMN) cell count. In ascitic fluid, a count of more of 250/mm 3 is highly indicative of SBP and is an indication for antibiotic therapy. However, the ascitic fluid total leukocyte and PMN count is not always available everywhere or cannot be done in an emergency basis.Use of reagent strip testing for leukocyte esterase has been proposed for the rapid diagnosis of meningitis, 6 empyema, 7 urinary tract infections, 8 and peritonitis in patients on peritoneal dialysis. 9 The leukocyte esterase present in the biologic fluid reacts with a chemical compound of the reagent strip causing a color change in the azo dye (purple). The aim of this prospective study is to assess the utility of reagent strips for the rapid diagnosis of SBP in cirrhotic patients with ascites. Patients and MethodsPatients. In a university-based hospital, for an 18-month period, we studied a group of nonselected paracentesis performed on a cohort of cirrhotic patients, at admission, when an SBP was suspected or was clinically indicated. To avoid equivocal results, paracentesis performed at 48 hours after diagnosis of SBP to control infection outcome was not included in the study. Diagnosis of cirrhosis was established by histologic criteria or...

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