Ascitic fluid infection in patients with hepatitis B virus-related liver cirrhosis: culture-negative neutrocytic ascites versus spontaneous bacterial peritonitis.
OBJECTIVE
Ascitic fluid infection (AFI) consists of culture-negative neutrocytic ascites (CNNA) and spontaneous bacterial peritonitis (SBP). The present study compared the clinical characteristics and prognosis of CNNA and SBP in hepatitis B virus (HBV)-related cirrhotic patients.


METHODS
We analyzed 130 consecutive patients hospitalized due to the first episode of AFI between January 1998 and December 2007.


RESULTS
The mean age of the patients was 52.3 years (88 men, 42 women). Ninety-three patients (71.5%) had CNNA and 37 patients (28.5%) had SBP; 117 patients (90.0%) died after a median survival period of 6.4 months. Patients with CNNA and SBP survived for a median period of 6.9 months and 5.4 months, respectively (P = 0.417). Patients with SBP showed higher in-hospital mortality than those with CNNA (16.2 vs 4.3%; P = 0.031). Binary logistic regression analysis showed that culture positivity of ascitic fluid (CNNA vs SBP) was the only independent predictor of in-hospital mortality (P = 0.042). In a Cox regression model for the 120 patients (92.3%) who survived the first episode of AFI, only the Child-Pugh score remained significant for survival (P = 0.007), whereas no association was observed for culture positivity of ascitic fluid (CNNA vs SBP) during the first episode of AFI (P = 0.752).


CONCLUSIONS
Although in-hospital mortality was higher in patients with SBP than CNNA, the clinical course of the two groups was similar after the first episode of AFI. Thus, liver transplantation should be considered, irrespective of culture positivity of ascitic fluid.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Seung Up
SU
Kim
Do Young
DY
Kim
Chun Kyon
CK
Lee
Jun Yong
JY
Park
Sun Hye
SH
Kim
Hee Man
HM
Kim
Eun Hee
EH
Choi
Sinyoung
S
Kim
Kwang-Hyub
KH
Han
Chae Yoon
CY
Chon
Sang Hoon
SH
Ahn
D001201:Ascites / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D001202:Ascitic Fluid / Q000382:microbiology*; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy / Q000821:virology*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D018579:Patient Selection; D010538:Peritonitis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome