Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Frequency and Clinical Presentations

Abstract

Objective: To determine the rate of spontaneous bacterial peritonitis (SBP) in patients of chronic liver disease with ascites and to determine their presenting clinical features.
Material and Methods: One hundred and three cirrhotic patients with ascites admitted in Medical Unit 3 of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from August 2020 to June, 2021 were included. Patients with non-cirrhotic ascites, recent antibiotic use or paracentesis and secondary bacterial peritonitis were excluded. Ascitic fluid sent for total and differential cell count, albumin and culture. SBP was diagnosed if neutrophil count was more than 250/cmm and/or there was positive ascitic fluid culture.
Results: Mean age of the patients was 51.55±12.64 years with range of 19 to 85 years. Fifty eight were male and 45 female. Fifty one (49.5 %) patients were found to have SBP. Among these, 33 (64.71 %) had culture negative neutrocytic ascites, 13 (25.49 %) had culture positive neutrocytic ascites and 5 (9.8 %) had culture positive non-neutrocytic ascites. Leukocyte count was significantly high in patients with SBP than those without SBP. Hepatic encephalopathy was presenting diagnosis in 31 patients of SBP, increasing abdominal
distension in 8 patients, abdominal pain and fever in 7 and upper gastrointestinal bleeding in 5 patients. Twenty four of 31 hepatic encephalopathy patients also had history of abdominal pain and fever.
Conclusion: Spontaneous bacterial peritonitis was common in admitted cirrhotic patients, and hepatic encephalopathy, abdominal pain and fever were the commonest presenting features in these patients