Clinical and laboratory features of spontaneous bacterial peritonitis

Spontaneous Bacterial Peritonitis (SBP) is a complication of cirrhosis. The mortality rate is approximately 30-50%. SBP is defined as an ascitic fluid infection in the absence of any obvious intraabdominal infectious foci. While earlier reports of SBP emphasized high mortality rates, recently lower mortality rates have been reported.

To evaluate the clinical and laboratory features and prognostic indicators of SBP.

Retrospective study.

Hacettepe University Hospitals.

A total of 281 SBP episodes of 214 patients between 3rd march 1981 and 3rd August 1999, in Hacettepe University Hospital were evaluated. Statistical analysis was performed in the group of patients having chronic liver diseases.

One hundred and forty nine of the patients 214 (69.6%) were males and 65(30.4%) were females. The mean age of all patients were 49.91+/-15.01 years (17 to 90 years). All spontaneous ascites infection episodes were symptomatic. In all of the episodes, most common clinical features were as follows: icterus (54.5%), abdominal tenderness (54.5%), hepatic encephalopathy (50.7%), fatigue (46.7%), abdominal pain (44.4%) and fever (38.8%). The culture of the ascitic fluid resulted in isolation of a bacteria in 25.4% of all episodes. The most frequently isolated microorganisms turned out to be gram negative enteric bacterias (76.2%). Sixty seven patients in 179 cases with liver disease passed away (37.4%). The use of cefotaxime and newer cephalosporins seemed to have less mortality (31.7%) as compared with that (42.2%) observed in patients treated with other antibiotic regimens.

Of all the factors analysed in patients with chronic liver diseases, being Child-Pugh class C, having fatigue, hepatic encephalopathy, hypotension, higher peripheral blood leukocyte count (> or =12000/mm3), renal dysfunction (serum creatinine level > or = 2mg/dl), longer prothrombin time (INR > or = 2.5), lower ascites protein level (