How Do Polymorphonuclear Counts in Ascitic Fluid Correlate to Hospital Outcome.

Area of Science:

• Infectious Diseases
• Hepatology
• Immunology

Background:

• Polymorphonuclear neutrophils (PMNs) are key in innate immunity.
• Ascitic fluid PMN counts are crucial for diagnosing spontaneous bacterial peritonitis (SBP) in liver cirrhosis patients.
• Current diagnostic guidelines for SBP rely on strict PMN count thresholds.

Purpose of the Study:

• To investigate the association between ascitic fluid PMN counts and hospital outcomes in liver cirrhosis patients.
• To assess the prognostic value of varying PMN levels beyond SBP diagnosis.
• To inform potential revisions of SBP diagnostic guidelines.

Main Methods:

• Retrospective analysis of de-identified data from HCA Healthcare hospitals (July 2013-December 2023).
• Inclusion of patients aged 18+ with liver cirrhosis undergoing paracentesis.
• Categorization of patients based on ascitic fluid PMN counts to evaluate mortality, 30-day readmission, and length of stay (LOS).

Main Results:

• Lower PMN counts (≤100 and ≤200 cells/mm³) were associated with increased mortality.
• Higher PMN counts (201-249 cells/mm³) showed reduced odds of mortality.
• 30-day readmissions had complex associations; higher counts linked to increased risk in the highest subgroup.
• Length of stay (LOS) did not significantly differ across PMN levels.

Conclusions:

• Ascitic fluid PMN counts have a nuanced role in prognostication for cirrhotic patients.
• Findings suggest a need to reconsider current diagnostic thresholds for SBP.
• Further research is warranted on PMN levels' implications for antimicrobial therapy and liver disease management.