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Characteristics of Pancreatic Cancer-associated Ascites and Redefined Criteria for Bacterial Peritonitis

Muhan Yeo1, In Rae Cho1, Sang Hyub Lee1

  • 1Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Pancreas
|December 15, 2025
PubMed
Abstract

Insights

New criteria for diagnosing bacterial peritonitis in pancreatic cancer ascites improve accuracy. Redefining diagnostic standards for polymorphonuclear (PMN) cell counts enhances specificity in patients with pancreatic ductal adenocarcinoma (PDAC).

Area of Science:

  • Gastroenterology and Hepatology
  • Oncology
  • Infectious Diseases

Background:

  • Spontaneous bacterial peritonitis diagnosis in cirrhosis uses polymorphonuclear (PMN) cell counts (>250/mm3).
  • Ascites in pancreatic ductal adenocarcinoma (PDAC) have mixed etiologies, differing from cirrhotic ascites.
  • Current diagnostic criteria may not accurately reflect bacterial peritonitis in PDAC patients.

Purpose of the Study:

  • To investigate the characteristics of ascites associated with PDAC.
  • To redefine diagnostic criteria for bacterial peritonitis in PDAC patients.
  • To improve the specificity of bacterial peritonitis diagnosis in PDAC.

Main Methods:

  • Retrospective analysis of PDAC-associated ascites from three Korean tertiary medical centers (n=493).
  • Analysis of ascites etiology (peritoneal carcinomatosis, portal hypertension, mixed) and characteristics.
  • Derivation and external validation (n=614) of new diagnostic criteria for bacterial peritonitis based on PMN cell proportion and counts.

Main Results:

  • PDAC ascites etiologies included peritoneal carcinomatosis, portal hypertension, and mixed.
  • PMN cell counts and proportions were significantly higher in peritoneal carcinomatosis compared to portal hypertension and mixed etiologies.
  • A redefined criterion (PMN cell proportion >35% with counts >250/mm3) increased diagnostic specificity from 85% to 92% in external validation.

Conclusions:

  • PDAC-associated ascites display distinct characteristics based on etiology.
  • Redefined diagnostic criteria enhance the specificity of bacterial peritonitis diagnosis in PDAC.
  • Improved diagnostic accuracy can lead to better patient management for PDAC-associated bacterial peritonitis.
Keywords:
ascitespancreatic neoplasmsperitonitisportal hypertension

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