Subacute Bacterial Peritonitis (SBP) in hospitalized cirrhotic patients

Objective: To compare the clinical and biochemical pattern of spontaneous bacterial peritonitis (SBP) versus non- SBP ascites in cirrhotic patients. Material and Methods: This case series was conducted at Medical C ward, Ayub Teaching Hospital, Abbottabad, Pakistan from 01-04-2008 to 31-03-2009 on 70 consecutive patients of liver cirrhosis. Relevant investigations were carried out to detect subacute bacterial peritonitis (SBP) and their clinical and demographic parameters were compared with non SBP cases. Results: Out of 70 cirrhotic patients, SBP was found in 26 patients (37.14%). Out of 26 patients with SBP, 17 were male. Classic SBP was found in 10 patients (39%), culture negative neutrocytic ascites (CNNA) in 13 patients (50%) and bacterial ascites (BA) in 3 patients (11%). Abdominal tenderness was present in 80.77% of SBP and 50.09% of Non-SBP cases. Most of the patients in SBP group belonged to Grade 2 Hepatic encephalopathy, whereas Non-SBP patients were predominantly in Grade 1 encephalopathy. Biochemical and bacteriological markers provided significant difference between the two groups including mean serum bilirubin (SBP vs. Non-SBP group = 7.21 ± 5.1 mg/ dl vs 2.18 ± 1.23mg/dl; p value=0.03) and ascitic fluid polymorphs (SBP vs. Non-SBP group = 1400±1200/cmm vs. 110±95/cmm; p=0.01). Conclusion: SBP occurred in more than one third cases of cirrhosis liver. Abdominal Clinical features alone could not rule out the diagnosis of SBP. Biochemical and bacteriological tests were more suggestive of diagnosis. Further studies are suggested to validate the results of this study. Key Words: Cirrhosis Liver, Ascites, Subacute Bacterial Peritonitis, Bacterial Ascites, Culture Negative Neutrocytic Ascites.