Role of Serial Ascitic Fluid Analysis and Other Prognostic Factors in Spontaneous Bacterial Peritonitis

Introduction: Cirrhosis of the liver is one of the commonly encountered liver disorders in clinical practice caused by a wide variety of etiologies. It is defined anatomically as a diffuse process of nodule formation and fibrosis in the liver. Spontaneous bacterial peritonitis (SBP) is defined by infection of the previously sterile ascitic fluid (AF), without any apparent intra-abdominal source of infection. SBP is one of leading cause of death in decompensated liver disease which need prompt diagnosis and treatment. There is increasing toll of alcoholic liver disease, and its complications in Assam in recent times. However, information regarding the clinical profile and bacteriological profile of SBP and its impact on outcome of cirrhotic patients is still lacking in many aspects in this part of the country. Aims and Objectives: This study was undertaken with an idea to evaluate the significance of serial AF analysis and other biochemical markers to determine prognosis in cirrhotic patients in this region. Materials and Methods: Patients admitted with hepatic cirrhosis with ascites were studied during the period from July 2013 to July 2014. All patients included in the study were confirmed hepatic cirrhosis either by liver biopsy or ultrasound with ascites presented with features of the SBP. Results: Total 50 patients of age group >12 years, were included and studied thoroughly with regards to both history and clinical examination. Higher total leukocyte count (>13,700/mm3), serum creatinine (>2 mg/dl) and low serum albumin (<2.2 g/dl), and AF protein (<1.086 g/dl) were significantly associated with increased mortality. Reduction in polymorphonuclear leukocyte count in serial AF analysis showed reduction in mortality. Conclusion: Increased total leukocyte count, low serum albumin, increased serum creatinine levels, and low AF protein are associated with poor prognosis. Serial AF cell count is helpful in predicting prognosis and can be used to monitor treatment.