A Study to Estimate Spontaneous Bacterial Peritonitis in Chronic Liver Disease

Abstract

Introduction: Spontaneous bacterial peritonitis (SBP) is an infection of initially sterile ascitic fluid without a detectable,
surgically treatable source of infection. We analyzed the prevalence, clinical and laboratory features of SBP in 100 patients
of chronic liver disease to identify risk factors for incidence and mortality. Material and methods: One hundred patients
(mean age 46 years, 92% males) with chronic liver disease and ascites were studied in our prospective study during the
period from October 2013 to November 2014 in Gajra Raja Medical College, Gwalior, Madhya Pradesh. Diagnosis of SBP
was based on: An ascitic fluid polymorphonuclear leukocyte (PMN) count ≥250/mm3 and ascitic fluid culture positive for
single microorganism With An absence of source of infection in abdomen. Clinical features of the patients were studied on
the basis of history and clinical examination. Relevant blood studies were sent as soon as possible and results analyzed.
Results: Overall prevalence of SBP was found to be 22% in our study. Symptoms significantly associated with increased
incidence of SBP were icterus (p value 0.036), altered sensorium (p value 0.012) and abdominal tenderness (p value 0.003).
Higher Child-Pugh grade (Grade C 18.4%) and increased MELD (p value 0.0009) score were associated with higher risk of
developing SBP. Also, increasing MELD score was associated with a higher mortality (p value 0.032). SBP +ve group was
associated with an increased mortality (p value 0.01) as compared to SBP -ve group. Mortality in SBP was strongly associated
with higher serum creatinine level (p value 0.0006). Conclusion: Icterus, altered sensorium, abdominal tenderness and raised
creatinine were associated with increased risk of SBP. Child-Pugh grade and MELD score were associated with increased risk
of SBP in cirrhosis in the present study. MELD score was found to be significantly associated with mortality in SBP.