title: Diagnostic parameters for spontaneous bacterial peritonitis in hepatitis B-related cirrhosis: comparison of ascitic fluid polymorphonuclear cell count, lactate and pH values.
abstract: BACKGROUND
  The clinical value of ascitic fluid pH or lactate in the diagnosis of spontaneous bacterial peritonitis was debated in alcoholic cirrhosis. It was rarely discussed in hepatitis B-related cirrhosis. We investigated the best rapid diagnostic method in spontaneous bacterial peritonitis of patients with hepatitis B-related cirrhosis.
  
  
  METHODS
  Ascitic fluid polymorphonuclear cell count, ascitic fluid pH, arterial-ascitic fluid pH gradient, ascitic fluid lactate, and arterial-ascitic fluid lactate gradient were analyzed in 79 patients with sterile portal hypertension-related ascites, 31 patients with spontaneous bacterial peritonitis, 16 patients with hepatocellular carcinoma, 15 patients with malignancy-related ascites and 9 patients with other miscellaneous diseases.
  
  
  RESULTS
  The sensitivity, specificity and accuracy of the diagnosis of spontaneous bacterial peritonitis were 100, 94 and 95% with the cut-off value of an ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3, and were 86, 98 and 96% with that value > or = 500 cells/mm3, respectively. The sensitivity, specificity and accuracy were 29, 92, 80% using ascitic fluid pH < or = 7.35 as a cut-off value; 38, 91, 82% using arterial-ascitic fluid pH gradient > or = 0.1 as a cut-off value; 52, 92, 85% using ascitic fluid lactate > or = 32 mg/dL as a cut-off value, and 38, 96, 85% using arterial-ascitic fluid lactate gradient > or = 20 mg/dL as a cut-off value.
  
  
  CONCLUSIONS
  The sensitivity of ascitic fluid pH or lactate was too low to aid in a diagnosis of spontaneous bacterial peritonitis in hepatitis B-related cirrhosis in spite of the acceptable specificity. An ascitic fluid polymorphonuclear cell count > or = 250 cells/mm3 or > or = 500 cells/mm3 was the major and appropriate aids in the rapid diagnosis of spontaneous bacterial peritonitis.
authors.affiliation: Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
authors.forename: M Y
authors.initials: MY
authors.lastname: Lee
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
authors.forename: C W
authors.initials: CW
authors.lastname: Lu
authors.forename: Y
authors.initials: Y
authors.lastname: Chao
authors.forename: F Y
authors.initials: FY
authors.lastname: Lee
authors.forename: S L
authors.initials: SL
authors.lastname: Wu
authors.forename: S D
authors.initials: SD
authors.lastname: Lee
authors.forename: Y T
authors.initials: YT
authors.lastname: Tsai
authors.forename: K J
authors.initials: KJ
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000166:cytology* / Q000378:metabolism; D001424:Bacterial Infections / Q000175:diagnosis*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007773:Lactates / Q000032:analysis* / Q000097:blood; D019344:Lactic Acid; D007958:Leukocyte Count; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010538:Peritonitis / Q000175:diagnosis*
chemical_list: D007773:Lactates; D019344:Lactic Acid