Open AccessAscitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites
Author(s) -
Simbrunner Benedikt,
Röthenbacher Annika,
Haslacher Helmuth,
Bauer David,
Chromy David,
Bucsics Theresa,
Schwabl Philipp,
Paternostro Rafael,
Scheiner Bernhard,
Trauner Michael,
Mandorfer Mattias,
Schwarzinger Ilse,
Reiberger Thomas
Publication year - 2019
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640619843000
Subject(s) - medicine , ascites , gastroenterology , confidence interval , hazard ratio , spontaneous bacterial peritonitis , absolute neutrophil count , ascitic fluid , subclinical infection , neutropenia , toxicity
Background Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A‐PMN) > 250 cells/µl. Objective We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP. Patients and methods A total of 178 patients were included and stratified by ascitic cell counts at index paracentesis: A‐LEUK‐low (<250/µl), A‐LEUK‐intermediate (250–500/µl) and A‐LEUK‐SBP (>500/µl) for leukocytes; A‐PMN‐low (<125/µl), A‐PMN‐intermediate (125–250/µl) and A‐PMN‐SBP (>250/µl) for PMN cells. Results One‐year mortality was comparable between group A‐LEUK‐SBP (53.9%) and patients with subclinical cell counts (34.5% for A‐LEUK‐low, 43.5% for A‐LEUK‐intermediate, log‐rank p = 0.547). However, we observed an increase in one‐year mortality already in group A‐PMN‐intermediate with 75% and A‐PMN‐SBP with 80.9% (vs 40.5% for A‐PMN‐low, log‐rank p = 0.016). Importantly, increases of A‐PMN cell counts between two paracenteses were associated with increased mortality: per 100 cells/µl increase of absolute A‐PMN cell count: hazard ratio (HR): 1.03 (95% confidence interval (CI): 1.01–1.06), p = 0.005; per 5% increase of relative PMN cell count: HR: 1.15 (95% CI: 1.06–1.26), p = 0.001. Conclusion Patients with PMN cell counts of 125–250/µl are at high risk for mortality, which was very similar to SBP patients with PMN cell counts >250/µl. This highlights the need for preventive strategies. The prognostic value of changes in relative ascitic PMN cell counts should be evaluated in future studies.