Spontaneous bacterial peritonitis laboratory findings: Difference between revisions
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* Absoulte neutrophil count - a total count of >250 cells/mm<sup>3</sup> confirm the diagnosis of spontaneous bacterial peritonitis. | * Absoulte neutrophil count - a total count of >250 cells/mm<sup>3</sup> confirm the diagnosis of spontaneous bacterial peritonitis. | ||
* When culture is positive, the most common organisms are Gram-negative bacteria (mainly ''[[Escherichia coli]]'') and Gram-positive cocci (usually [[Streptococcus]] spp. and [[enterococci]]).<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8228129 }} </ref> | * When culture is positive, the most common organisms are Gram-negative bacteria (mainly ''[[Escherichia coli]]'') and Gram-positive cocci (usually [[Streptococcus]] spp. and [[enterococci]]).<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8228129 }} </ref> | ||
* If the diagnosis is doubtful, the serum procalcitonin level has a 95% sensitivity, and 98% specificity | * If the diagnosis is doubtful, the serum procalcitonin level has a 95% sensitivity, and 98% specificity with a cutoff of 0.75 ng/mL.<ref name="pmid11030164">{{cite journal| author=Viallon A, Zeni F, Pouzet V, Lambert C, Quenet S, Aubert G et al.| title=Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines. | journal=Intensive Care Med | year= 2000 | volume= 26 | issue= 8 | pages= 1082-8 | pmid=11030164 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11030164 }} </ref> | ||
* Some patients may have an ascitic neutrophil count <250 cells/mm<sup>3</sup> with positive cultures. This is known as "bacterascites". This patients should undergo a second [[paracentesis]]. Patients with signs of [[Systemic inflammatory response syndrome]] ([[SIRS]]) or in whom the repeat ascitic neutrophil count is >250 cells/mm<sup>3</sup> should receive antibiotic therapy, if not, they should be followed up.<ref name="pmid20633946">{{cite journal| author=European Association for the Study of the Liver| title=EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. | journal=J Hepatol | year= 2010 | volume= 53 | issue= 3 | pages= 397-417 | pmid=20633946 | doi=10.1016/j.jhep.2010.05.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20633946 }} </ref> | * Some patients may have an ascitic neutrophil count <250 cells/mm<sup>3</sup> with positive cultures. This is known as "bacterascites". This patients should undergo a second [[paracentesis]]. Patients with signs of [[Systemic inflammatory response syndrome]] ([[SIRS]]) or in whom the repeat ascitic neutrophil count is >250 cells/mm<sup>3</sup> should receive antibiotic therapy, if not, they should be followed up.<ref name="pmid20633946">{{cite journal| author=European Association for the Study of the Liver| title=EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. | journal=J Hepatol | year= 2010 | volume= 53 | issue= 3 | pages= 397-417 | pmid=20633946 | doi=10.1016/j.jhep.2010.05.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20633946 }} </ref> | ||
* Albumin concentration - it is important for the calculation of [[serum-ascites albumin gradient]] , this helps us in identifying the [[portal hypertension]] and prognosis. | * Albumin concentration - it is important for the calculation of [[serum-ascites albumin gradient]] , this helps us in identifying the [[portal hypertension]] and prognosis. | ||
Revision as of 20:28, 16 June 2014
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Spontaneous bacterial peritonitis Microchapters |
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Differentiating Spontaneous bacterial peritonitis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Guillermo Rodriguez Nava, M.D. [3]
Overview
Diagnosis requires paracentesis (needle drainage of the ascitic fluid). Ascites culture is negative in up to 60% of patients with clinical manifestations of spontaneous bacterial peritonitis (SBP), therefore, the diagnosis is based on the neutrophil count, which reaches its highest sensitivity with a cutoff neutrophil count of > 250/mm3.[1]
Laboratory Findings
Laboratory tests, most importantly ascitic fluid analysis is required for confirmation of diagnosis of spontaneous bacterial peritonitis.
- Complete blood count and differential count are tested to confirm infection.
- Serum electrolytes and creatinine to asses the renal function.
- Liver function tests are to performed for evaluation of cirrhosis.
- Blood cultures may be useful in sepsis
- Urine culture to rule out asymptomatic bacteriuria
Ascitic Fluid Analysis
- Absoulte neutrophil count - a total count of >250 cells/mm3 confirm the diagnosis of spontaneous bacterial peritonitis.
- When culture is positive, the most common organisms are Gram-negative bacteria (mainly Escherichia coli) and Gram-positive cocci (usually Streptococcus spp. and enterococci).[2]
- If the diagnosis is doubtful, the serum procalcitonin level has a 95% sensitivity, and 98% specificity with a cutoff of 0.75 ng/mL.[3]
- Some patients may have an ascitic neutrophil count <250 cells/mm3 with positive cultures. This is known as "bacterascites". This patients should undergo a second paracentesis. Patients with signs of Systemic inflammatory response syndrome (SIRS) or in whom the repeat ascitic neutrophil count is >250 cells/mm3 should receive antibiotic therapy, if not, they should be followed up.[1]
- Albumin concentration - it is important for the calculation of serum-ascites albumin gradient , this helps us in identifying the portal hypertension and prognosis.
- Protein concentration - low protein concentration is noticed in cases of spontaneous bacterial peritonitis which differentiates it from secondary bacterial peritonitis where it is normal.
References
- ↑ 1.0 1.1 European Association for the Study of the Liver (2010). "EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis". J Hepatol. 53 (3): 397–417. doi:10.1016/j.jhep.2010.05.004. PMID 20633946.
- ↑ Caly WR, Strauss E (1993). "A prospective study of bacterial infections in patients with cirrhosis". J Hepatol. 18 (3): 353–8. PMID 8228129.
- ↑ Viallon A, Zeni F, Pouzet V, Lambert C, Quenet S, Aubert G; et al. (2000). "Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines". Intensive Care Med. 26 (8): 1082–8. PMID 11030164.