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Infected and noninfected ascites in pediatric patients
Sandra M G Vieira1, Ursula Matte, Carlos O Kieling
1Hospital de Clínicas de Porto Alegre, Brazil. smvieira@hcpa.ufrgs.br
Insights
In pediatric patients with portal hypertensive ascites, infected ascites occurred in 29.2% of cases. Clinical and laboratory features, except for serum albumin, did not significantly differ between infected and noninfected ascites groups.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Portal hypertensive ascites is a serious complication in pediatric liver disease.
- Infections in ascites, such as spontaneous bacterial peritonitis, can worsen patient outcomes.
- Distinguishing infected from noninfected ascites is crucial for timely treatment.
Purpose of the Study:
- To determine the prevalence of spontaneous bacterial peritonitis and other bacterial infections in pediatric patients with portal hypertensive ascites.
- To compare the clinical and laboratory features of infected versus noninfected ascites in this population.
Main Methods:
- A study of 41 episodes of portal hypertensive ascites in 31 pediatric patients.
- Analysis included ascites fluid analysis (cell count, pH, biochemistry, Gram stain, culture) and blood tests.
- Statistical comparison using Mann-Whitney and chi tests to differentiate infected and noninfected ascites.
Main Results:
- Infected ascites (including spontaneous bacterial peritonitis) was found in 29.2% of episodes.
- Fever, voluminous ascites, and encephalopathy were common but not significantly different between groups.
- No significant differences in clinical or most laboratory features (except serum albumin) were observed between infected and noninfected ascites.
Conclusions:
- The prevalence of infected ascites in pediatric portal hypertensive ascites is substantial.
- Clinical and biochemical markers are not reliable indicators for differentiating infected from noninfected ascites, except for serum albumin levels.
Objectives:
To determine the prevalence of spontaneous bacterial peritonitis, ascites with bacterial infection and noninfected ascites in pediatric patients with portal hypertensive ascites and to compare the clinical and laboratory features of infected and noninfected ascites.
Methods:
Forty-one episodes of portal hypertensive ascites (serum-ascites albumin gradient >1.1 g/dL) in 31 patients were studied. Median age was 2.9 years. Twenty-four (77.4%) patients were cirrhotic and 20 (83.3%) were classified as Child-Pugh C. Median pediatric end-stage liver disease score was 18.5. The following ascites features were assessed: polymorphonuclear neutrophil cell count, cytology, pH, concentration of glucose, lactic dehydrogenase, total protein and albumin, Gram stain and bacteriological culture. Blood was sampled for complete blood count, coagulation studies, liver and renal function tests. Groups were compared by Mann-Whitney and chi tests (P < 0.05).
Results:
Noninfected ascites were observed in 29 of 41 samples, spontaneous bacterial peritonitis in eight of 41 and ascites with bacterial infection in four of 41. The most prevalent clinical features were fever, voluminous ascites and encephalopathy, but there were no significant differences in the clinical features of the groups. All patients with infected ascites were cirrhotic. There was no statistical difference in Child-Pugh or pediatric end-stage liver disease status between patients with infected and noninfected ascites. Culture of ascetic fluid was positive in four of eight cases of spontaneous bacterial peritonitis. Gram-negative rods were the most prevalent bacteria cultured. Except for serum albumin, no statistical differences in biochemical markers were observed between patients with infected and noninfected ascites.
Conclusions:
The prevalence of infected ascites was 29.2%. With the exception of serum albumin, there were no differences in the clinical and biochemical features of patients with infected ascites and noninfected ascites.
