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Journal of Hepato-Gastroenterology

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Predictors of spontaneous bacterial peritonitis in patients with cirrhotic ascites

Author(s): Khaled Metwally*, Tamer Fouad, Medhat Assem, Eman Abdelsameea and Mohamed Yousery

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis and finding a prognostic model to predict it is needed. Objective: to test the ability of different laboratory tests and the new scoring system consisting of age, CRP and platelet count by Wehmeyer and colleagues to predict it. METHODS: 300 patients admitted at the National Liver Institute, University of Menoufyia, Egypt (2015-2016) with liver cirrhosis and ascites were included in our study. SBP was diagnosed if ascetic neutrophils count ≥ 250/μL with no sign of secondary peritonitis. RESULTS: Age range (29 –81 years), 60% men and primary cause of liver disease were hepatitis C, 91.7%. By univariate analysis: age, total bilirubin, AST, creatinine, INR, MELD score, total leucocytic count, platelet count and CRP were significant. By multivariate analysis independent predictors were age, platelet count and CRP (p=0.004, 0.013 and<0.001, respectively). CRP at a cutoff point ≥ 13.5 mg/L could predict SBP (sensitivity 86.4%and specificity 66.0%). Wehmeyer’s SBP scoring system was able to predict it (p<0.001), only 4% of patients with 0 score developed SBP (CRP cutoff is 30 mg/L), while 92.8% with score of 3 or 4 developed it. By using our modified Wehmeyer score, CRP cutoff value of 13.5 mg/L, no patient with 0 score developed SBP. CONCLUSION: Age, CRP and platelet count are independent predictors for SBP and a scoring system including them could easily predict it. SBP diagnosis could be excluded inpatients with zero score, using CRP cutoff value of 13.5 mg/L.

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