title: Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients.
abstract: OBJECTIVE
  To compare the incidence of spontaneous bacterial peritonitis in cirrhotic outpatients and inpatients undergoing therapeutic paracentesis
  
  
  METHODS
  From January 1 to May 31, 2004, 1041 patients from 70 different hospitals underwent 2123 therapeutic abdominal paracentesis (AP) performed as a outpatient procedure in 355 and as inpatient procedure in 686 cases respectively. The following parameters were compared prospectively between outpatients and inpatients: spontaneous bacterial peritonitis (SBP) prevalence, age, gender, cause of cirrhosis, symptoms, score and grade according to Child-Pugh classification, cirrhosis complications, antibiotics treatment, serum creatinine, platelet count and ascitic protein concentration.
  
  
  RESULTS
  SBP was observed in 91 patients. In the whole population the SBP prevalence was 8.7% (95%CI: 7.2-10.6) it was 11.7% (95%CI: 9.5-14.3) in inpatients and 3.1% (95%CI: 1.7-5.5) in outpatients (P < 0.00001). SBP prevalence was 8.3% (95%CI: 4.3-15.6) in symptomatic outpatients vs 1.2% (95%CI: 0.4-3.4) in asymptomatic outpatients (P < 0.002). Patients undergoing outpatient AP were significantly different from those undergoing inpatient AP; they were older (61.1 ± 11.1 years vs 59.4 ± 11.7 years; P = 0.028), cause of cirrhosis was less often alcohol (83 .7 vs 88.2%; P < 0.001), Child-Pugh score was lower (8.9 vs 10.1; P < 0.001) and more often B than C (63.7% vs 38%; P < 0.001). In addition, in outpatients the platelet count was higher (161 ± 93 Giga/L vs 143 ± 89 Giga/L; P = 0.003), serum total bilirubin concentration was lower (38.2 ± 60.7 μmol/L vs 96.3 ± 143.3 μmol/L; P < 0.0001), and ascitic protein concentration higher (17.9 ± 10.7 g/L vs 14.5 ± 10.9 g/L; P < 0.001) than in inpatients.
  
  
  CONCLUSIONS
  In asymptomatic cirrhotic outpatients, the incidence of spontaneous bacterial peritonitis is low thus exploratory paracentesis could be avoided in these patients without significant risk.
authors.affiliation: Jean-François Cadranel, Liver, Gastroenterology and Nutrition Department, Centre Hospitalier Laennec, 60100 Creil, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nousbaum
authors.forename: Christophe
authors.initials: C
authors.lastname: Bessaguet
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.forename: Eric
authors.initials: E
authors.lastname: Nguyen-Khac
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Thierry
authors.initials: T
authors.lastname: Thévenot
authors.forename: Christine
authors.initials: C
authors.lastname: Silvain
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Olivier
authors.initials: O
authors.lastname: Nouel
authors.forename: Christophe
authors.initials: C
authors.lastname: Pilette
authors.forename: Thierry
authors.initials: T
authors.lastname: Paupard
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pauwels
authors.forename: Thierry
authors.initials: T
authors.lastname: Sapey
authors.forename: Jean-Didier
authors.initials: JD
authors.lastname: Grangé
authors.forename: Albert
authors.initials: A
authors.lastname: Tran
keywords: Ascites; Ascitic fluid; Bacterial infections; Liver cirrhosis; Paracentesis; Peritonitis
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