Relative Ascites Polymorphonuclear Cell Count Indicates Bacterascites and Risk of Spontaneous Bacterial Peritonitis

Lutz, Philipp; Goeser, Felix; Kaczmarek, Dominik J.; Schlabe, Stefan; Nischalke, Hans Dieter; Nattermann, Jacob; Hoerauf, Achim; Strassburg, Christian P.; Spengler, Ulrich

doi:10.1007/s10620-017-4637-4

Cited by 20 publications

(28 citation statements)

References 30 publications

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“…In our cohort, Gram‐negative bacteria were frequently isolated in culture‐positive SBP patients, which is consistent with the result of a previous report . However, Gram‐positive bacteria were the most frequent type of strain in bacterascites patients, and this result is in line with the findings of recent studies of bacterascites . Patients with cirrhosis are susceptible to various infections that may be caused by bacteria with low virulence.…”

Section: Discussionsupporting

confidence: 93%

Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study

Gao

Wang

et al. 2020

Liver International

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Background & Aims: Current guidelines on the management of bacterascites are limited. This multicentre, retrospective study investigated the clinical features and outcomes of cirrhosis patients with bacterascites. Methods: Two series of cirrhosis patients were evaluated. The first included 418 patients with ascites-positive cultures at 11 hospitals during 2012-2018. Clinical characteristics and outcomes were recorded. The second included 208 patients with sterile ascites from a prospective cohort (NCT02457637). Clinical features and outcomes of cirrhotic patients with or without bacterascites were investigated.Results: In the first series, bacterascites was diagnosed in 254/418 (60.8%) patients, and culture-positive spontaneous bacterial peritonitis (SBP) in 164/418 (39.2%) patients. Gram-positive bacteria were more prevalent in bacterascites patients than in culture-positive SBP patients (59.1% vs 22.0%; P < .001). For patients with acuteon-chronic liver failure (ACLF) in bacterascites and culture-positive SBP groups, the 28-day transplant-free mortality (41.3% vs 65.5%; P = .015) and the prevalence of inhospital acute kidney injury (AKI) (84.8% vs 75%; P = .224). For patients without ACLF

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Section: Discussionsupporting

confidence: 93%

Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study

Gao

Wang

et al. 2020

Liver International

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“…With the results of this study, it is difficult to clearly elucidate the underlying pathogenesis of bacterascites. Gram‐positive bacteria were frequently isolated in bacterascites, which is in line with findings from other bacterascites series . However, only a minority of episodes of bacterascites was considered to be due to exogenous contamination.…”

Section: Discussionsupporting

confidence: 87%

“…To the best of our knowledge, this is one of the first studies concentrating solely on bacterascites by analysing a large cohort of consecutive patients. Our cohort with 123 patients is substantially larger than previously reported cohorts including 18‐48 patients . One of the limitations of this study is that, because of the retrospective design, the natural course of bacterascites could not be optimally studied.…”

Section: Discussionmentioning

confidence: 91%

“…It is a different clinical entity than spontaneous bacterial peritonitis (SBP), which is characterized by a neutrophil reaction in ascites regardless of the bacterial culture result. Bacterascites is prevalent in 8%‐11% of all patients with cirrhosis and ascites, and the clinical significance seems to vary according to how the infection was acquired …”

Section: Introductionmentioning

confidence: 99%

“…Although bacterascites is not an uncommon condition, relatively few studies on prognostic factors and outcome of this ascitic fluid infection have been reported . Therefore, the purpose of this study was to assess the clinical characteristics, microbiological findings, and clinical course in consecutive patients diagnosed with bacterascites.…”

Section: Introductionmentioning

confidence: 99%

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Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Oey

Buuren

Jong

et al. 2018

Liver International

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BackgroundKnowledge about bacterascites is limited and management guidelines are based on small patient series. The purpose of this study was to add further insight into the clinical characteristics, microbiological findings, and prognosis of patients diagnosed with bacterascites.MethodsRetrospective analysis of patients with advanced chronic liver disease diagnosed with bacterascites and SBP between January 2003 and August 2016.ResultsIn this study, 123 patients were included with 142 episodes of bacterascites. The median MELD score was 20 and clinical symptoms of infection were present in 78%. Empiric antibiotic treatment was initiated in 68%. In 26 untreated patients undergoing repeated paracentesis, 42% were diagnosed with either ongoing bacterascites or SBP. The presence of signs or symptoms of infection was not an independent predictor for mortality or spontaneous resolution of infection. The 1‐month and 1‐year mortality rates of the 123 patients studied, were 32% and 60%, respectively; these results were in line with data pertaining to the prognosis of SBP.ConclusionsPatients with bacterascites and SBP are highly comparable with respect to severity of liver disease and overall prognosis. If left untreated, bacterascites is likely to persist or to evolve to SBP in a significant proportion of patients. The results of this study support current guidelines regarding the treatment of ascitic fluid infection, but could not confirm the prognostic relevance of symptomatic disease at the time of diagnosis. We suggest that the threshold to initiate antibiotic treatment, in particular in cases with severely advanced liver disease, should be low.

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Chinese guidelines on the management of ascites in cirrhosis

Xu,

Ding,

Jia

et al. 2024

Hepatol Int

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Relative Ascites Polymorphonuclear Cell Count Indicates Bacterascites and Risk of Spontaneous Bacterial Peritonitis

Abstract: The relative PMN count is a cheap immunological marker linked to bacterascites and future SBP, which may help to stratify patients according to their risk of infection.

Cited by 20 publications

References 30 publications

Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study

Clinical features and outcomes of bacterascites in cirrhotic patients: A retrospective, multicentre study

Bacterascites: A study of clinical features, microbiological findings, and clinical significance

Chinese guidelines on the management of ascites in cirrhosis

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