Spontaneous bacterial peritonitis in cirrhosis of liver with ascites -a cross sectional study

Abstract

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal complication of cirrhosis of liver with ascites, both in alcoholic and non-alcoholic liver disease, although more common in former case. AIMS : To determine the prevalence of spontaneous bacterial peritonitis (SBP) and its clinical profiles in patients of cirrhosis of liver with ascites. STUDY DESIGN : A cross sectional study. PATIENTS : A total of 50 patients of cirrhosis of liver with ascites. METHODS : These patients were diagnosed on the basis of clinical evaluation, biochemical investigation, ultrasongraphy of the abdomen, ascitic fluid examination for protein, PMN count, and bacterial culture using conventional method. RESULTS : Prevalence of SBP in these patients was 18%. The commonest clinical variant of SBP observed was Culture Negative Neutrocytic Ascites ( CNNA), present in 77.78% of patients. 11.11% had Mono microbial Non neutrocytic Bacterascites (MNBA), and remaining 11.11% of patients had Classic Spontaneous Bacterial Peritonitis (C-SBP). 88.89% of the patients showed one or the other clinical manifestation and 11.11% were asymptomatic. In symptomatic patients, chief clinical features observed were abdominal pain, fever, hepatic encephalopathy and rebound tenderness. Among laboratory parameters, mean serum biliribin was 6.48mg/dl, serum albumin was 2.41gm/dl, SPTR was 7.6 sec and mean ascitic fluid protein concentration was 93gm/dl. Ascitic fluid culture was positive in 22.22% of cases. Organisms isolated were E-coli in C-SBP patient and S.aureus in MNBA patient. 88.89% of patients who had SBP were in Child-Pugh’s class ‘C’ server liver disease. 22.22% patients with SBP expired during the hospital stay. CONCLUSION: With these observations, it can be concluded that, SBP is one of the common complication of cirrhosis of liver with ascites. As a proportion of these patients remain asymptomatic, high degree of clinical suspicion, backed by relevant laboratory investigation are key for its accurate diagnosis and subsequent effective treatment, neverless, death can be an inevitable outcome.