Predictors of Spontaneous Bacterial Peritonitis in Patients with Cirrhotic Ascites

Abstract

Background and Aims: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and a prognostic model to predict it is needed. This study was designed to test the ability of different laboratory tests and the new scoring system by Wehmeyer and colleagues (consisting of age, C-reactive protein (CRP) and platelet count) to predict it.Methods: Three-hundred patients admitted to the National Liver Institute, University of Menoufia, Egypt (2015–2016) with liver cirrhosis and ascites were included in our study. SBP was diagnosed if ascetic neutrophil count was ≥250/µL with no sign of secondary peritonitis.Results: The patient population had age range of 29–81 years old, was 60% men and showed a majority (91.7%) with primary cause of liver disease being hepatitis C. By univariate analysis, associations with age, total bilirubin, aspartate aminotransferase level, creatinine level, international normalized ratio, model for end-stage liver disease score, total leucocytic count, platelet count and CRP level were significant. By multivariate analysis, independent predictors were age, platelet count and CRP level (p = 0.004, 0.013 and <0.001, respectively). CRP at a cut-off point ≥13.5 mg/L could predict SBP (sensitivity of 86.4% and specificity of 66.0%). Wehmeyer’s SBP scoring system was predictive (p < 0.001); only 4% of patients with 0 score developed SBP (CRP cut-off of 30 mg/L), while 92.8% with score of 3 or 4 developed SBP. By using our modified Wehmeyer score with CRP cut-off value of 13.5 mg/L, no patient with 0 score developed SBP.Conclusions: Age, CRP level and platelet count are independent predictors for SBP and a scoring system including them could easily predict the condition. SBP diagnosis could be excluded in patients with 0 score, using CRP cut-off value of 13.5 mg/L.

Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil‑to‑lymphocyte ratio

“…Our study showed that there was a significant difference between the mean values of BT, creatinine, INR, serum WBC, serum albumin and PLT in the SBP group compared to those without SBP. The mean values of BT, creatinine, INR, and serum WBC were significantly higher, and the mean PLT was significantly lower, in a group of 59 patients with SBP from a study with 300 patients with liver cirrhosis (14). But in contrast with our study results, there was no statistically significant difference in serum albumin values between the groups.…”

Ascitic calprotectin as a useful marker in the diagnosis of spontaneous bacterial peritonitis in adults

“…In the current study, the measurement of serum or ascitic nitrous oxide did not add a benefit in SBP diagnosis. Patients with SBP had higher serum CRP level, which is consistent with the other studies [12,14,19]. Furthermore, serum hsCRP was higher in SBP patients in accord with Guler et al [6] study.…”

“…The hsCRP has a higher sensitivity than CRP. Patients with SBP show elevated CRP levels that decrease with treatment [12,14,19]. Only one study by Guler et al [6] assessed the role of serum hsCRP in nonneutrocytic ascites.…”

Blood Neutrophil / Lymphocyte Ratio and C –Reactive Protein / Albumin Ratio as Markers of Response for Treatment of Spontaneous Bacterial Peritonitis

“…As regarding, liver profile and kidney function tests in our study, there were disturbances in both liver profile and kidney functions reported among cirrhotic ascitic patients with and without SBP which can be explained by liver cell failure that agreed with Metwally et al, [19].…”