Spontaneous bacterial peritonitis in ascitic patients with hepatic encephalopathy

ABSTRACT

Thirty six patients with ascites and hepatic encephalopathy where the precepitating factor was unknown were examined. Ascitic fluid [AF] was examined for pH, absolute polymorphnuclear cell count [PMN] and for presence of bacteria by bedside inoculation blood culture bottles with AF. Patients were classified into 3 groups. Group I. Spontaneous bacterial peritonitis [SBP] PMN > 250 cell/mm[3] + positive culture. Group II. Probable spontaneous bacterial peritonitis PMN > 250 cell/mm[3] + negative culture. [PSBP]. Group III. Sterile ascites [SA] PMN < 250 cell/mm[3] + negative culture. PMN was significantly higher while pH was significantly lower in Group [I+II] when compared with group III. p.H was found to have prognostic significance as mortality rate was high below pH 7.2. The incidence of SPp + PsBp was found to be high 33% [25% SBP + 8% OPSBP]. The mortality rate in treated encephalopathic patients with SBP + PSBP was 33%, while in the S.A. it was 42%. This difference was statistically insignificant. We conclude that in Cirrhotic patients with ascites and unexplained encephalopathy ascitic fluid should be examined for evidence of SBP