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Relative Ascites Polymorphonuclear Cell Count Indicates Bacterascites and Risk of Spontaneous Bacterial Peritonitis

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Abstract

Background and Aims

Absolute polymorphonuclear (PMN) counts in ascites define spontaneous bacterial peritonitis (SBP), a severe form of bacterial infection in liver cirrhosis. Bacterascites, another form of ascites infection, can progress to SBP or may resolve spontaneously but is not reflected by absolute PMN counts. We investigated whether the relative ascites PMN count (the absolute PMN count divided by the absolute leukocyte count) provides additional information to detect bacterascites or predict SBP.

Methods

Hospitalized patients with liver cirrhosis requiring paracentesis were stratified with respect to a diagnosis of bacterascites and SBP with a prospective follow-up for 1 year. Diagnostic power of relative PMN counts in ascites was evaluated by receiver operating characteristics curves.

Results

At inclusion, we observed 28/269 (10%) and 43/269 (16%) episodes of BA and SBP, respectively. Unlike absolute PMN counts, relative PMN counts in ascites were significantly elevated in bacterascites (p = 0.001). During follow-up, 16 and 30 further episodes of BA and SBP were detected, respectively. Relative PMN counts increased significantly once patients developed BA (p = 0.001). At a threshold of 0.20 for the relative PMN count, sensitivity, specificity, positive and negative predictive values for bacterascites which required antibiotic treatment were 83, 75, 26 and 98%, respectively (p < 0.001). Furthermore, a relative PMN count in ascites ≥0.13 and MELD score >17 was independent factors associated with occurrence of SBP during follow-up.

Conclusion

The relative PMN count is a cheap immunological marker linked to bacterascites and future SBP, which may help to stratify patients according to their risk of infection.

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Abbreviations

SBP:

Spontaneous bacterial peritonitis

BA:

Bacterascites

PMN:

Polymorphonuclear

HCC:

Hepatocellular carcinoma

MELD:

Model for end-stage liver disease

AUROC:

Area under the receiver operating characteristics curve

ROC:

Receiver operating characteristics

PPV:

Positive predictive value

NPV:

Negative predictive value

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Funding

This study was funded by a clinical leave stipend from the German Center for Infection Research to PL.

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Authors and Affiliations

  1. Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany

    Philipp Lutz, Felix Goeser, Dominik J. Kaczmarek, Stefan Schlabe, Hans Dieter Nischalke, Jacob Nattermann, Christian P. Strassburg & Ulrich Spengler

  2. Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Achim Hoerauf

  3. German Center for Infection Research, Bonn, Germany

    Philipp Lutz, Felix Goeser, Dominik J. Kaczmarek, Stefan Schlabe, Hans Dieter Nischalke, Jacob Nattermann, Achim Hoerauf, Christian P. Strassburg & Ulrich Spengler

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  1. Philipp Lutz
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Correspondence to Philipp Lutz.

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Lutz, P., Goeser, F., Kaczmarek, D.J. et al. Relative Ascites Polymorphonuclear Cell Count Indicates Bacterascites and Risk of Spontaneous Bacterial Peritonitis. Dig Dis Sci 62, 2558–2568 (2017). https://doi.org/10.1007/s10620-017-4637-4

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