Primary ascitic fluid infection in patients with chronic liver diseases

The aim of the study: to evaluate primary ascitic fluid infection (PAFI) among patients with chronic liver disease (CLD), to study the incidence, clinical features, laboratory findings and short term prognosis of PAFI and also to evaluate factors that may affect incidence and prognosis. . Patients and Methods: Seventy eight patients with CLD were studied between July 1996- to July 1997 in Baghdad Teaching Hospital. Results: thirteen patients developed PAFI (16.7%), no significant differences in the age or gender between the infected and the non-infected groups were found. (P>0.05). The incidence of PAFI is significantly higher among patients with Child′s Pugh class C (P< 0.005). Low ascitic fluid protein (< 10g/L) was more common among the infected group, yet this does not reach statistical significance (P>0.05). The presenting symptoms were abdominal pain (53.8%), fever (46.2%); abdominal tenderness (38.5%), encephalopathy (30.7%), hypotension (15.3%), full triad (15.3%) and asymptomatic patients at presentation were (30.7%). Ascitic fluid culture (by conventional methods) was positive in 46%. All the culture positive samples grew Gram-negative bacilli; E. coli being the most common microorganism (50%). Among five parameters (age, positivity of ascitic fluid culture, severity of CLD, presence of encephalopathy and lack of peritoneal irritation signs), only the increased age seems to be associated with higher in-hospital mortality.