Spontaneous bacterial peritonitis results in oxidative and nitrosative stress in ascitic fluid

Natarajan, Sathish Kumar; Mukhopadhya, Ashis; Ramachandran, Anup; Amalanathan, Sophia; Kurian, George; Balasubramanian, K.A.

doi:10.1111/j.1440-1746.2006.04400.x

Cited by 8 publications

(3 citation statements)

References 34 publications

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“…Natarajan et al and Wojtacha et al, reported a high incidence of bilirubin, liver enzymes, albumin, total protein disturbance in patients with SBP when compared to the non-infected cases [18,19]. Liver dysfunction is known to impair the defense mechanisms against infection seen in cirrhotic patients because of depressed reticuloendothelial system phagocytic activity, reduced serum complement levels and low antibacterial activity of asitic fluid [18]. …”

Section: Discussionmentioning

confidence: 99%

Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study

et al. 2011

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BackgroundSpontaneous bacterial peritonitis (SBP) is a serious complication in infants and children with chronic liver disease (CLD); however its diagnosis might be difficult. We aimed to study the feasibility of diagnosing SBP by routine ascitic fluid tapping in infants and children with CLD.MethodsWe enrolled thirty infants and children with biopsy-proven CLD and ascites. Ascitic fluid was examined for biochemical indices, cytology and cell count. Aerobic and anaerobic bacteriological cultures of ascitic fluid were preformed. Direct smears were prepared from ascitic fluid deposit for Gram and Zheil-Nelson staining.ResultsPatients were divided into three groups: Group I included five patients with SBP in which the cell count was ≥ 250/mm3 and culture was positive (16.7%), Group II, eight patients with culture negative neutrocytic ascites (CNNA) with cells ≥ 250/mm3 and negative culture (26.7%) and Group III, seventeen negative patients (56.6%) in which cells were <250/mm3 and culture was negative. None of our patients had bacteriascites (i.e. culture positive with cells <250/mm3). Presence of fever was significantly higher in SBP and CNNA. The mean lactate dehydrogenase (LDH) level was significantly higher in ascitic fluid in the infected versus sterile cases (p < 0.002). A ratio of ascitic/serum LDH ≥ 0.5 gave a sensitivity of 80%, specificity of 88%, positive predictive value (PPV) of 66.7%, negative predictive value (NPV) of 93.7% and accuracy of 63.3%. The mean pH gradient (arterial - ascitic) was significantly higher in SBP and CNNA cases when compared to the negative cases (p < 0.001). Ascitic fluid protein level of ≤ 1 gm/dl was found in 13/30 (43.3%) of studied cases with a sensitivity of 100%, specificity of 64.7%, PPV of 45.5%, NPV of 100% and diagnostic accuracy of 53.3% (p = 0.0001).ConclusionsSBP is a rather common complication in children with CLD. Culture of the ascitic fluid is not always diagnostic of infection. Biochemical parameters of the ascitic fluid definitely add to the diagnostic accuracy. LDH ascitic/serum ratio ≥ 0.5, an arterial-ascitic pH gradient ≥ 0.1 and total ascitic fluid protein ≤ 1 gm/dl are the most significant parameters suggesting infection.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study

et al. 2011

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“…Although precise mechanisms of SBP in patients with ascites are unclear, increased oxidative stress and overproduction of inflammatory mediators such as cytokines leading to development and aggravation of peritonitis have been proposed [5,13]: abdominal exudates from the patients with peritonitis have revealed that the tremendous amount of ROS [14] which may cause destruction in a wide variety of defense systems, e.g. an inactivation of the alpha 1-proteinase inhibitor leading to unrestrained synthesis of inflammatory mediators during peritonitis [15].…”

Section: Discussionmentioning

confidence: 99%

Serum albumin level accurately reflects antioxidant potentials in idiopathic nephrotic syndrome

et al. 2011

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“…Those patients are particularly susceptible to infections with a higher prevalence in cirrhotics [ 2 ]. Liver dysfunction is known to impair defense mechanisms against infection because of depressed reticuloendothelial system phagocytic activity, reduced serum complement levels and low antibacterial activity of ascitic fluid [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory?

Ghobrial¹,

Mogahed²,

El‐Karaksy³

2018

PLoS ONE

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Ascitic fluid infection is a major cause of morbidity and mortality in cirrhotic patients, requiring early diagnosis and therapy. We aimed to determine predictors of ascitic fluid infection in children with chronic liver disease. The study included 45 children with chronic liver disease and ascites who underwent 66 paracentesis procedures. Full history taking and clinical examination of all patients were obtained including fever, abdominal pain and tenderness and respiratory distress. Investigations included: complete blood count, C-reactive protein, full liver function tests, ascitic fluid biochemical analysis, cell count and culture. Our results showed that patients’ ages ranged between 3 months to 12 years. Prevalence of ascitic fluid infection was 33.3%. Gram-positive bacteria were identified in six cases, and Gram-negative bacteria in five. Fever and abdominal pain were significantly more associated with infected ascites (p value = 0.004, 0.006). Patients with ascitic fluid infection had statistically significant elevated absolute neutrophilic count and C-reactive protein. Logistic regression analysis showed that fever, abdominal pain, elevated absolute neutrophilic count and positive C-reactive protein are independent predictors of ascitic fluid infection. Fever, elevated absolute neutrophilic count and positive C-reactive protein raise the probability of ascitic fluid infection by 3.88, 9.15 and 4.48 times respectively. The cut-off value for C-reactive protein for ascitic fluid infection was 7.2 with sensitivity 73% and specificity of 71%. In conclusion, prevalence of ascitic fluid infection in pediatric patients with chronic liver disease and ascites was 33.3%. Fever, abdominal pain, positive C-reactive protein and elevated absolute neutrophilic count are strong predictors of ascitic fluid infection. Therefore an empirical course of first-line antibiotics should be immediately started with presence of any of these predictors after performing ascitic fluid tapping for culture and sensitivity. In absence of these infection parameters, routine ascitic fluid analysis could be spared.

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Spontaneous bacterial peritonitis results in oxidative and nitrosative stress in ascitic fluid

Abstract: This study demonstrated the presence of oxidative stress in ascitic fluid from patients with SBP, and showed that ascitic fluid nitrate may be a marker for diagnosing SBP and a useful index in determining therapeutic response to antibiotic treatment.

Cited by 8 publications

References 34 publications

Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study

Diagnosis of spontaneous bacterial peritonitis in infants and children with chronic liver disease: A cohort study

Serum albumin level accurately reflects antioxidant potentials in idiopathic nephrotic syndrome

Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory?

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