Skip to main content
Log in

Prevalence and prognostic significance of bacterascites in cirrhosis with ascites

  • Liver: Cirrhosis, Fibrosis, Portal Hypertension, And Transplantation
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The prevalence and prognostic significance of bacterascites (BA) were prospectively studied in 443 predominantly HBsAg-positive cirrhotic patients with ascites. Spontaneous bacterial peritonitis (SBP), culture-negative neutrocytic ascites (CNNA), and BA were identified in 12.4%, 8.4%, and 10.8%, respectively. Of these, 67%, 70%, and 71%, respectively, had peritonitis-related signs or symptoms. Among patients with SBP or CNNA, the clinical and laboratory data showed no significant difference between the symptomatic and asymptomatic groups. In contrast, among the patients with BA, the symptomatic group had significantly higher levels of serum total bilirubin and prolonged prothrombin time and significantly lower levels of ascitic fluid total protein than the asymptomatic group. Furthermore, the clinical and laboratory data were relatively similar between patients with asymptomatic BA and those with sterile ascites. In contrast, patients with SBP, CNNA, or symptomatic BA exhibited significantly more severe degrees of liver disease and significantly lower levels of ascitic fluid total protein than those with sterile ascites. There was no statistically significant difference between SBP and bacterascites regarding flora. All patients with SBP, CNNA, or symptomatic BA received antibiotic treatment immediately after paracentesis, as did six of the 14 patients with asymptomatic BA for concurrent respiratory or urinary tract infection, while the remaining eight patients with asymptomatic BA were followed clinically without treatment. Repeated paracentesis in the latter revealed no evidence of SBP or CNNA. The in-hospital mortality for sterile ascites was 22.8%, significantly lower than the 54.5% for SBP, 43.2% for CNNA, and 50% for symptomatic BA, but similar to the 21.4% for asymptomatic BA. In conclusion, 11% of cirrhotic patients with ascites had BA as a complication. Of these, 71% were symptomatic and 29% were asymptomatic. The former might be an SBP variant, while the latter might represent transient colonization of ascitic fluid with bacteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Conn HO, Fessel JM: Spontaneous peritonitis in Lannec's cirrhosis caused by enteric organism: A relative common but rarely recognized syndrome. Ann Intern Med 60:568–580, 1964

    PubMed  Google Scholar 

  2. Conn HO, Fessel JM: Spontaneous bacterial peritonitis in cirrhosis: Variation on a theme. Medicine (Baltimore) 50:161–167, 1971

    PubMed  Google Scholar 

  3. Correia JP, Conn HO: Spontaneous bacterial peritonitis in cirrhotic ascites: Endemic or epidemic. Med Clin North Am 59:963–981, 1974

    Google Scholar 

  4. Bar-meir S, Lerner E, Conn HO: Analysis of ascites fluid in cirrhosis. Dig Dis Sci 24:136–143, 1979

    PubMed  Google Scholar 

  5. Yang CY, Liaw YF, Chu CM, Sheen IS: White count, pH and lactate in ascites in the diagnosis of spontaneous bacterial peritonitis. Hepatology 5:85–90, 1985

    PubMed  Google Scholar 

  6. Chu CM, Chiu KW, Liaw YF: The prevalence and prognostic significance of spontaneous bacterial peritonitis in severe acute hepatitis with ascites. Hepatology 15:799–803, 1992

    PubMed  Google Scholar 

  7. Hoefs JC, Runyon BA: Spontaneous bacterial peritonitis. Dis Mon 31:1–48, 1985

    Google Scholar 

  8. Runyon BA, Hoefs JC: Culture-negative neutrocytic ascites: A variant of spontaneous bacterial peritonitis. Hepatology 4:1209–1211, 1984

    PubMed  Google Scholar 

  9. Runyon BA: Monomicrobial nonneutrocytic bacterascites: A variant of spontaneous bacterial peritonitis. Hepatology 12:710–715, 1990

    PubMed  Google Scholar 

  10. Pinzello G, Simonetti RG, Craxi A, Di Piazza S, Spano C, Paglinro L: Spontaneous bacterial peritonitis: A prospective investigation in predominantly nonalcoholic cirrhotic patients. Hepatology 3:545–549, 1983

    PubMed  Google Scholar 

  11. Wyke RJ: Problems of bacterial infection in patients with liver disease. Gut 28:623–641, 1987

    PubMed  Google Scholar 

  12. Wilcox CM, Dismukes WE: Spontaneous bacterial peritonitis: Review of pathogenesis, diagnosis and treatment. Medicine 66:447–456, 1987

    PubMed  Google Scholar 

  13. Reynolds TB: Rapid presumptive diagnosis of spontaneous bacterial peritonitis. Gastroenterology 90:1294–1297, 1986

    PubMed  Google Scholar 

  14. Conn HO: Spontaneous bacterial peritonitis: Multiple revisitations. Gastroenterology 70:455–457, 1976

    PubMed  Google Scholar 

  15. Attali P, Turner K, Pelletier G, Ink O, Etienne JP: pH of ascitic fluid diagnostic and prognostic value in cirrhotic and non cirrhotic patients. Gastroenterology 90:1255–1260, 1986

    PubMed  Google Scholar 

  16. Pelletier GP, Ink O, Hagege H, Attali P, Buffet C, Etienne JP: Asymptomatic bacterascites: Is it spontaneous bacterial peritonitis. Hepatology 14:112–115, 1991

    PubMed  Google Scholar 

  17. Almdal TP, Skinhoj P: Spontaneous bacterial peritonitis in cirrhosis: Incidence, diagnosis and prognosis. Scand J Gastroenterol 22:295–300, 1987

    PubMed  Google Scholar 

  18. Runyon BA: Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis. Gastroenterology 91:1343–1345, 1986

    PubMed  Google Scholar 

  19. Wang SS, Tsai YT, Lee SD, Chen HT, Lu CW, Lee FY, Jeng JS, Liu YC, Lo KJ: Spontaneous bacterial peritonitis in patients with hepatitis B-related cirrhosis and hepatocellular carcinoma. Gastroenterology 101:1656–1662, 1991

    PubMed  Google Scholar 

  20. Hurwich DB, Lindor KD, Hay JE, Gross JB, Kaese D, Rakela J: Prevalence of peritonitis and the ascitic fluid protein concentration among chronic liver disease patients. Am J Gastroenterol 88:1254–1257, 1993

    PubMed  Google Scholar 

  21. Runyon BA, Hoefs JC, Canawati HN: Polymicrobial bacterascites: a unique entity in the spectrum of infected ascitic fluid. Arch Intern Med 146:2173–2175, 1986

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chu, CM., Chang, KY. & Liaw, YF. Prevalence and prognostic significance of bacterascites in cirrhosis with ascites. Digest Dis Sci 40, 561–565 (1995). https://doi.org/10.1007/BF02064369

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02064369

Key Words

Navigation