Clinical Impression and Ascites Appearance Do Not Rule Out Bacterial Peritonitis

Chinnock, Brian; Hendey, Gregory W.; Minnigan, Hal; Butler, Jack M.; Afarian, Hagop

doi:10.1016/j.jemermed.2012.07.086

Cited by 14 publications

(8 citation statements)

References 11 publications

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“…The timely diagnosis and management of SBP requires the recognition that a history of advanced liver disease with ascites alone is sufficient to mandate paracentesis. It is clear that clinical impression alone is inadequate to rule out a diagnosis of SBP . Secondly, as many of these patients are admitted through the emergency department and indeed may spend the majority of their initial 12 h following hospital presentation receiving triage care in this setting, the effectiveness of this EDP approach will require awareness and engagement of emergency department physicians.…”

Section: Discussionmentioning

confidence: 99%

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

et al. 2019

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Background Spontaneous bacterial peritonitis (SBP) is common in hospitalized cirrhotic patients with ascites and carries high mortality. This study aimed to determine whether early diagnostic paracentesis (EDP) <12 h of hospitalization conveys an intermediate‐term (6‐month) survival benefit in cirrhotic patients diagnosed with SBP. Methods Consecutive US veterans with cirrhosis diagnosed with SBP over 13 years at a single VA medical center were reviewed retrospectively. Kaplan‐Meyer analyses assessed the effects of EDP on survival. Results A total of 79 cirrhotic patients were diagnosed with SBP (61.8 ± 8.8 years, n = 77 male, n = 52 [66.8%] Caucasian, n = 23 [29.1%] African‐American). Underlying liver diseases included hepatitis c viral infection (HCV) (17.5%), alcohol (28.6%), alcohol and HCV (30.1%), and cryptogenic/metabolic (15.9%). Median baseline model for end‐stage liver disease (MELD) was 12 (range 6–34), and median MELD at presentation was 18. Seven subjects had a history of hepatocellular carcinoma (11.1%), and 26 (41.3%) presented with sepsis. Thirty‐three (52.4%) subjects died within 6 months after the SBP admission. Of the subjects, 41 (65.1%) underwent EDP, of which 23 (56.0%) survived at least 6 months, compared to only 7 of the 22 patients (31.8%) undergoing paracentesis >12 h from presentation (P = 0.057). The maximal benefit of EDP on survival was observed beyond days 14 and 30; at these time points, no statistical difference in mortality was discernable (P = 0.55 and 0.71). In a multivariate model including age, MELD at admission, hepatocellular cancer, and sepsis criteria, EDP (p 0.034) positively impacted patient survival at 6 months. Conclusions EDP is associated with improved 6‐month mortality in cirrhotic patients with ascites. In this veteran cohort, EDP was as important as MELD as a predictor of intermediate‐term survival.

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Section: Discussionmentioning

confidence: 99%

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

et al. 2019

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“…The diagnosis is made in the presence of an elevated absolute polymorphonuclear leukocyte count ≥250 cells/mm3 in the ascitic fluid (2). The prevalence of SBP in hospitalized patients with cirrhosis and ascites is estimated at 11-14% (3–5). Various cohort studies have examined in-hospital mortality associated with SBP through the last few decades.…”

Section: Introductionmentioning

confidence: 99%

Mortality from Spontaneous Bacterial Peritonitis Among Hospitalized Patients in the USA

et al. 2018

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“…A análise do líquido ascítico deve incluir contagem de neutrófilos para o diagnóstico de PBE e a dosagem total de proteínas. Embora a aparência do líquido ascítico, como a presença de turvação, tenha uma sensibilidade de 98 % na detecção de PBE e uma coloração clara indique uma menor probabilidade de infecção, com base em uma revisão retrospectiva de mais de 900 amostras, sua aparência não pode ser usada como um marcador confiável para atingir ou excluir o diagnóstico (CHINNOCK, et al 2013).…”

Section: Manejo Diagnósticounclassified

Manejo Da Peritonite Bacteriana Espontânea Na Emergência

Ferreira¹,

Melo²,

Nunes³

et al. 2022

Teoria E Prática Trauma E Emergência - Ed. 3ª Vol. 1

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Clinical Impression and Ascites Appearance Do Not Rule Out Bacterial Peritonitis

Cited by 14 publications

References 11 publications

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

Survival benefit associated with early detection of spontaneous bacterial peritonitis in veteran inpatients with cirrhotic ascites

Mortality from Spontaneous Bacterial Peritonitis Among Hospitalized Patients in the USA

Manejo Da Peritonite Bacteriana Espontânea Na Emergência

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