Diagnostic utility of absolute neutrophil count as a new marker of spontaneous bacterial peritonitis; multicenter study

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a fatal complication of liver cirrhosis with high mortality rates. The aim of this study is to investigate the diagnostic utility of absolute neutrophil count (ANC) as a noninvasive marker for SBP diagnosis. Methods: Six hundred patients with cirrhotic ascites were included in the study. All patients underwent abdominal paracentesis and the ascitic fluid was processed for cell count and culture. Results: Absolute neutrophil count was significantly higher in SBP versus non-SBP and in culture positive SBP versus culture negative SBP. ANC at cutoff value > 2.804 has 84% sensitivity and 78% specificity for diagnosis of SBP with positive and negative predictive values (79.4% and 83.6 respectively). At a cut-off point > 5.6, ANC is capable of differentiating culture positive SBP from culture negative SBP cases with 62.07% sensitivity and 60.87 % specificity. Increased ANC, white blood cell (WBC), C reactive protein (CRP), creatinine and decreased platelet emerged as independent risk factors for SBP development, while increased ANC, WBC and decreased platelets were independent predictors of culture positive SBP. Conclusion:This study demonstrates that, ANC count is simple, non-invasive diagnostic marker for SBP. Increased ANC, WBC, CRP, creatinine and decreased platelet emerged as independent risk factors for SBP development. Materials and methodsIn this prospective study, we recruited 600 patients with liver cirrhosis and ascites referred to Tropical and