A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites with Special Reference to Serial Ascitic Fluid Cell Count as Prognostic Marker
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 1
Abstract
Aim: To study clinical features and prognostic significance of various clinical, biochemical parameters and serial ascitic fluid cell count in SBP.. Study design: Prospective, observational, single centre, non-blind (open label). Place and duration of study: General Medicine Department, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Vizianagaram Dist, India from October 2014 to September 2016. Methodology: 50 patients admitted to MIMS General Hospital, Nellimarla, diagnosed as cirrhosis of liver with SBP were studied. SBP was diagnosed based on ascetic fluid cell PMN count of > 250. Serial ascitic fluid cell count was done at 0 hour, 24 hours, 48 hours, and at 5 days. The results were compared between the survivors and non-survivors and subjected to appropriate statistical analysis.. Results: Male:Female ratio in SBP patients was 2:1. Mean age at the time of diagnosis was 53.68 +/- 9.06 years (37 – 75 years). Common clinical features were - jaundice(64 %), fever(56 %), abdomen pain(56 %), altered sensorium(40%), haemetemesis or malena (36 %) and oliguria(32 %), icterus (84 %), asterixis (48 %), hypotension (24 %), abdominal tenderness (68%).Ascitic fluid culture did not show any growth in 48 % of cases while 24 % showed E. Coli, 20 % showed klebsiella, and 4 % each of proteus and staphylococcus aureus. Outcome was grave with 44 % mortality. Conclusion: : TLC above 11,000/mm3, total bilirubin above > 5mg/dl and sr. creatinine > 1.5 were associated with increased mortality. An ascetic fluid PMN count of > 600 at time of diagnosis, > 700 at 24 hours and > 450 at 48hours was associated with poor prognosis. A progressive fall in serial ascitic fluid cell PMN count was associated with good prognosis.
Authors and Affiliations
Dr. Sushanth Vemuganti, Dr. M. K. Sagar, Dr. S. C. Mohapatra, Dr. P. Satya Raju, Dr. S. Prasanna Kumar, Dr. K. S. Roshni
Keywords
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- EP ID EP578021
- DOI 10.9790/0853-1701101732.
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