Abstract
The clinical significance and prognosis of culture-negative neutrocytic ascites in cirrhotic patients is a controversial topic. In the present study, the clinical and humoral presentation and the short-and long-term prognosis were analyzed in 36 patients with cirrhosis and culture-positive spontaneous bacterial peritonitis and in 28 patients with cirrhosis and ascitic fluid polymorphonuclear count greater than 250/mm3, a negative ascitic fluid culture, and without previous antibiotic therapy. On admission there were no significant differences between groups related to age, sex, alcoholism, fever, abdominal pain, serum albumin, serum urea, serum creatinine, Child-Pugh score, polymorphonuclear count, and total protein concentration in ascitic fluid. A greater frequency of positive blood culture was found in patients with spontaneous bacterial peritonitis (15/21 vs 2/18) (P<0.001). Mortality during the first episode was 36% in patients with spontaneous bacterial peritonitis and 46% in patients with culture-negative neutrocytic ascites (NS). Mortality during follow-up was high and survival probability at 12 months was 32% in spontaneous bacterial peritonitis and 31% in culture-negative neutrocytic ascites. The probability of recurrence at 12 months was 33% in spontaneous bacterial peritonitis and 34% in culture-negative neutrocytic ascites. Our results show that spontaneous bacterial peritonitis and culture-negative neutrocytic ascites are variants of the same disease with a high mortality and poor prognosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Runyon BA, Hoefs JC: Culture-negative neutrocytic ascites: A variant of spontaneous bacterial peritonitis. Hepatology 4:1209–1211, 1984
Pelletier G, Salmon D, Ink O, et al: Culture-negative neutrocytic ascites: A less severe variant of spontaneous bacterial peritonitis. J Hepatol 10:327–331, 1990
Conn HO, Fessel MJ: Spontaneous bacterial peritonitis in cirrhosis: a variation on a theme. Medicine 50:161–197, 1971
Pinzello G, Simonetti RG, Craxi A, Di Piazza S, Spano C, Pagliaro L: Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic patients. Hepatology 3:545–549, 1983
Fong T, Akriviadis EA, Runyon BA, Reynolds TB: Polymorphonuclear cell count response and duration of antibiotic therapy in spontaneous bacterial peritonitis. Hepatology 9:423–426, 1989
Weinstein MP, Iannini PB, Stratton CW, Eikhoff TC: Spontaneous bacterial peritonitis. A review of 28 cases with emphasis on improved survival and factors influencing prognosis. Am J Med 64:592–598, 1978
Hoefs JC, Canawati HN, Sapico FL, Hopkins RR, Weiner J, Montgomery JZ: Spontaneous bacterial peritonitis. Hepatology 2:399–407, 1982
Kamerer J, Taieb M, Dupeyron C, Vuillemin N, Lelvan G, Fovet P: Peritonitis bacteriennes spontanees du cirrhotique. Gastroenterol Clin Biol 3:709–718, 1979
Le Carrer M, Poupon RY, Petit J, et al: Les infections du liquide d'ascite chez le cirrhotique: étude clinique et biologique de 36 episodes observes au course d'une année. Gastroenterol Clin Biol 4:640–645, 1980
Tito L, Bimola A, Gines P, Llach J, Arroyo V, Rodes J: Recurrence of spontaneous bacterial peritonitis in cirrhosis: Frequency and predictive factors. Hepatology 8:27–31, 1988
Ink O, Pelletier G, Salmon D, et al: Pronostic de l'infection spontanée d'ascite chez le cirrhotique. Gastroentrol Clin Biol 13:556–561, 1989
Runyon BA, Canawati HN, Akriviadis EA: Optimization of ascitic fluid culture technique and explanation of the insensitivity of the conventional method. Hepatology 7:1055, 1987 (abstract)
Runyon BA, Hoefs JC: Ascitic fluid analyses in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology 4:447–450, 1984
Runyon BA, Umblad ET, Merlin T: Inoculation of blood culture bottles with ascitic fluid. Improved detection of spontaneous bacterial peritonitis. Arch Intern Med 147:73–75, 1987
Akriviadis EA, Runyon BA: Utility of algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 98:127–133, 1990
Felisart J, Rimola A, Arroyo V, et al: Cefotaxime is more effective than is ampicillin-tobramicin in cirrhotics with severe infections. Hepatology 5:457–462, 1985
Runyon BA, Akriviadis EA, Antillon IG, Mc Hutchison JG, Montano A: Short course versus long course therapy of spontaneous peritonitis; a randomized trial of 70 patients. Gastroenterology 1989 (abstract)
Planas R, Rimola A, Sanchez-Tapias JM, Peres J, Bruguera M, Rodes J: Antibioticos orales no absorbibles en el tratamiento de la peritonitis espontanea de la cirrosis hepatica. Gastroenterol Hepatol 4:499–503, 1981
Grange J, Amiot X, Grange V, et al: Amoxicillin-clavulamic acid therapy of spontaneous bacterial peritonitis. A prospective study of twenty seven cases in cirrhotic patients. Hepatology 11:360–364, 1990
Cabrera J, Arroyo V, Ballesta A, et al: Aminoglycoside nephrotoxicity in cirrhosis. Value of urinary B2 microglobulin to discriminate functional renal failure from acute tubular damage. Gastroenterology 82:97–105, 1982
Moore R, Smith C, Lietman P: Increased risk of renal dysfunction due to interaction of liver disease and aminoglycosides. Am J Med 80:1993–1996, 1985
Silvain CH, Mannant P, Ingrand P, Fort E, Besson I, Beauchant M: Recidive de l'infection spontanée du liquide d'ascite au cours de la cirrhose. Gastroenterol Clin Biol 15:106–109, 1991
Rimola A, Bory F, Teres J, Peres Ayuso R, Arroyo V, Rodes J: Oral nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology 5:463–467, 1985
Soriano G, Teixido M, Guarner C, et al: Oral norfloxacin decreases the incidence of spontaneous bacterial peritonitis in hospitalized cirrhotics with ascites. J Hepatol 1989 (abstract)
Gines P, Rimola A, Planas R, et al: Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis. Results of a double blind placebo-controlled trial. Hepatology 12:716–724, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Terg, R., Levi, D., Lopez, P. et al. Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Digest Dis Sci 37, 1499–1504 (1992). https://doi.org/10.1007/BF01296493
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296493