%0 Journal Article
%T Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients
%A Jean-Fran£¿ois Cadranel
%A Jean-Baptiste Nousbaum
%A Christophe Bessaguet
%A Pierre Nahon
%J World Journal of Hepatology
%D 2013
%I Baishideng Publishing Group Co. Limited
%R 10.4254/wjh.v5.i3.104
%X AIM: 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 ¡À 11.1 years vs 59.4 ¡À 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 ¡À 93 Giga/L vs 143 ¡À 89 Giga/L; P = 0.003), serum total bilirubin concentration was lower (38.2 ¡À 60.7 ¦Ìmol/L vs 96.3 ¡À 143.3 ¦Ìmol/L; P < 0.0001), and ascitic protein concentration higher (17.9 ¡À 10.7 g/L vs 14.5 ¡À 10.9 g/L; P < 0.001) than in inpatients. CONCLUSION: In asymptomatic cirrhotic outpatients, the incidence of spontaneous bacterial peritonitis is low thus exploratory paracentesis could be avoided in these patients without significant risk.
%K Liver cirrhosis
%K Ascites
%K Ascitic fluid
%K Bacterial infections
%K Paracentesis
%K Peritonitis
%U http://www.wjgnet.com/1948-5182/full/v5/i3/104.htm