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

Area of Science:

• Hepatology
• Infectious Diseases
• Clinical Immunology

Background:

• Spontaneous bacterial peritonitis (SBP) is a severe infection in liver cirrhosis, diagnosed by absolute polymorphonuclear (PMN) counts in ascites.
• Bacterascites (BA) is another ascites infection that may precede SBP but is not identified by absolute PMN counts.
• The diagnostic utility of relative ascites PMN counts for detecting BA and predicting SBP requires further investigation.

Purpose of the Study:

• To investigate if the relative ascites PMN count provides additional information for detecting bacterascites (BA).
• To evaluate the predictive value of relative ascites PMN counts for the development of spontaneous bacterial peritonitis (SBP).
• To assess the relative PMN count as a potential biomarker for stratifying infection risk in liver cirrhosis patients.

Main Methods:

• Prospective follow-up of hospitalized liver cirrhosis patients undergoing paracentesis for 1 year.
• Stratification of patients based on diagnoses of bacterascites (BA) and spontaneous bacterial peritonitis (SBP).
• Evaluation of the diagnostic power of relative PMN counts using receiver operating characteristic (ROC) curves.

Main Results:

• Relative ascites PMN counts were significantly elevated in bacterascites (p=0.001), unlike absolute PMN counts.
• A relative PMN count threshold of 0.20 showed 83% sensitivity and 75% specificity for detecting antibiotic-requiring bacterascites.
• A relative PMN count ≥0.13, along with a MELD score >17, independently predicted future SBP development.

Conclusions:

• The relative PMN count is an accessible and cost-effective immunological marker.
• This marker is associated with bacterascites and the future risk of spontaneous bacterial peritonitis.
• Relative PMN counts can assist in stratifying patients based on their risk of ascites infection.