title: Usefulness of routine analysis of ascitic fluid at the time of therapeutic paracentesis in asymptomatic outpatients. Results of a multicenter prospective study.
abstract: OBJECTIVE
  The guidelines of the American Association for the Study of Liver Diseases recommend performing exploratory paracentesis on each patient with cirrhosis and chronic ascites. The aim of the study was to evaluate the prevalence of spontaneous bacterial peritonitis and culture-negative neutrocytic ascites in a large population of consecutive asymptomatic cirrhotic ascitic ambulatory patients.
  
  
  METHODS
  Patients with cirrhosis and tense ascites hospitalized from January to September 2000 in 5 hepatogastroenterology units prospectively underwent an exploratory paracentesis with cytobacteriological, biochemical and bedside inoculation into aerobic and anaerobic blood culture bottles. Patients studied were not receiving antibiotics except for norfloxacin and had no obvious sign of infection such as fever or hypothermia, chills, unusual abdominal tenderness, de novo or worsening hepatic encephalopathy, recent gastrointestinal bleeding, acute renal failure or marked arterial hypotension. Clinical and biological findings and ascitic fluid cytological and bacteriological results were evaluated at each exploratory paracentesis. The results are given in mean +/- standards deviations with range.
  
  
  RESULTS
  Sixty-seven cirrhotic patients (48M/19F, mean age 59 +/- 9 years) had 270 therapeutic paracenteses, preceded by an exploratory aspiration. Fifty-nine patients (88%) had alcoholic cirrhosis. Twenty-five patients (37.3%) received norfloxacin. At first paracentesis 41 (61.2%) and 26 (38.8%) patients were class B and C respectively according to the Child-Pugh classification; the mean Child-Pugh score was 9 +/- 1.5. None had suspicion of infection. The mean number of paracenteses was 5 +/- 4.3 per patient; 59.6% of the paracenteses (161) were compensated with human albumin. Ascitic protein concentration was 17.5 +/- 8.6 g/l, ascitic fluid cell count and number of neutrophils were 127 +/- 155/mm3 and 5.9 +/- 14/mm3 (0-60), respectively. No patient had spontaneous bacterial peritonitis nor culture-negative neutrocytic ascites; 10 cases of monomicrobial bacterascites were observed, all with commensal germs.
  
  
  CONCLUSIONS
  In the absence of obvious signs of infection, the prevalence of spontaneous bacterial peritonitis and culture-negative neutrocytic ascites in asymptomatic cirrhotic outpatients with ascites is near 0%. Moreover, for 100 large volume paracenteses, not performing exploratory paracentesis corresponds to a savings of 5,500 euros, without risk for these patients.
authors.affiliation: Service d'Hépato-Gastroentérologie et Diabétologie, Centre Hospitalier Laënnec, Creil.
authors.forename: Rémy
authors.initials: R
authors.lastname: Romney
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrié
authors.forename: Chantal
authors.initials: C
authors.lastname: Halimi
authors.forename: Abdel
authors.initials: A
authors.lastname: Medini
authors.forename: Patrice
authors.initials: P
authors.lastname: Lemaitre
authors.forename: Philippe
authors.initials: P
authors.lastname: Gruaud
authors.forename: Vincent
authors.initials: V
authors.lastname: Jouannaud
authors.forename: Thierry
authors.initials: T
authors.lastname: Delacour
authors.forename: Hamza
authors.initials: H
authors.lastname: Boudjema
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pauwels
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Chaput
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001201:Ascites / Q000378:metabolism*; D001202:Ascitic Fluid / Q000737:chemistry* / Q000166:cytology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D009643:Norfloxacin / Q000627:therapeutic use; D019152:Paracentesis; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis
chemical_list: D000890:Anti-Infective Agents; D011506:Proteins; D009643:Norfloxacin