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Increased Mortality with Intermediate Ascitic Polymorphonuclear Cell Counts Amongst Patients with Cirrhosis: Time to
Shahid Habib1, Michael Ball2, Chris Thomas2
1Liver Institute PLLC, Tucson, AZ 85716, USA.
Background:
Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with decompensated cirrhosis and ascites. Diagnosis typically relies on an ascitic polymorphonuclear (A-PMN) cell count ≥ 250 cells/high-power field (HPF).
Methods:
In this retrospective cohort study, 117 hospitalized patients with acute decompensation of chronic liver disease and a diagnostic paracentesis were evaluated. Clinical, laboratory, and imaging data were collected. Patients were stratified by A-PMN counts of ≤50, 51-249, or ≥250 cells/HPF. Additional analysis was performed with patients stratified by ascitic white blood cell (WBC) count and albumin. Mortality risk was assessed at 28, 90, and 365 days.
Results:
Patients with A-PMN ≤ 50 cells/HPF had the lowest 28-day mortality (8%). At 90 and 365 days, mortality risk was significantly higher for the A-PMN 51-249 cells/HPF group (90-day hazard ratio (HR) 3.55, p = 0.01; 365-day HR 2.43, p = 0.02), but not A-PMN ≥ 250 cells/HPF group (90-day HR 2.95, p = 0.1; 365-day HR 2.95, p = 0.2). Ascitic WBC count did not significantly predict mortality, though higher counts were associated with extraperitoneal infections. Ascitic fluid albumin ≤ 1.0 g/dL was independently associated with increased 365-day mortality (HR 3.53, p = 0.03).
Conclusions:
Binary SBP A-PMN thresholds may not adequately capture mortality risk in cirrhotic patients with ascites. Low ascitic albumin and intermediate A-PMN counts are associated with increased long-term mortality, suggesting the need for more nuanced diagnostic and prognostic criteria in SBP evaluation.
Insights
Spontaneous bacterial peritonitis (SBP) diagnosis using polymorphonuclear cell counts may miss mortality risks. Intermediate cell counts and low ascitic albumin indicate higher long-term mortality in cirrhosis patients.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) is a severe complication in patients with decompensated cirrhosis and ascites.
- Current diagnosis relies on ascitic fluid polymorphonuclear (A-PMN) cell count ≥ 250 cells/high-power field (HPF).
Purpose of the Study:
- To evaluate the prognostic value of A-PMN counts and ascitic fluid albumin in predicting mortality in cirrhotic patients with ascites.
- To determine if current diagnostic thresholds for SBP adequately identify patients at risk for mortality.
Main Methods:
- Retrospective cohort study of 117 hospitalized patients with decompensated cirrhosis and ascites.
- Patients were stratified by A-PMN counts (≤50, 51-249, ≥250 cells/HPF), ascitic white blood cell (WBC) count, and albumin levels.
- Mortality risk was assessed at 28, 90, and 365 days post-paracentesis.
Main Results:
- Patients with A-PMN ≤ 50 cells/HPF had the lowest 28-day mortality (8%).
- Intermediate A-PMN counts (51-249 cells/HPF) were associated with significantly higher 90-day and 365-day mortality.
- Low ascitic fluid albumin (≤1.0 g/dL) independently predicted increased 365-day mortality.
Conclusions:
- Standard binary A-PMN thresholds may not fully capture mortality risk in SBP.
- Intermediate A-PMN counts and low ascitic albumin are crucial indicators of increased long-term mortality.
- More nuanced diagnostic and prognostic criteria are needed for SBP evaluation in cirrhotic patients.
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