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首页> 外文期刊>Journal of Advances in Internal Medicine >Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?
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Serial Ascitic Fluid Analysis – Prognostic Marker for Adverse Outcome in Spontaneous Bacterial Peritonitis in Liver Cirrhosis?

机译：连续性腹水分析–肝硬化自发性细菌性腹膜炎不良结果的预后标志物？

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Background: Cirrhosis is a frequent cause of hospital admissions in Nepal with spontaneous bacterial peritonitis (SBP) being a major determinant of mortality. Limited diagnostic options preclude early risk stratification to improve patient outcomes. We assessed the predictive value of polymorphonuclear leukocyte counts (PMNs) and its association with mortality in hospitalized SBP patients.Methods: We examined 51 cirrhotic patients diagnosed with SBP in a prospective case-control study admitted to a Nepali tertiary care facility from February 2010 to November 2012. Serial paracentesis and ascitic fluid analysis were performed at admission, 24, and 48 hours. Receiver operating characteristic (ROC) curves, repeated measures analysis of variance, and logistic regression evaluated ascitic PMNs as predictors of mortality.Results: Deceased patients demonstrated significantly elevated mean circulating and ascitic PMNs. Ascitic PMNs in the non-survivors were significantly elevated upon admission and at 24 and 48 hours. These differences were significant based on absolute counts, relative differences and trends across time. ROC curves provided diagnostic thresholds (1600, 860, 500 cells/mm3) distinguishing the two groups upon presentation, at 24 and 48 hours respectively, with high sensitivities (100%), specificities (82.5-97.5%), and positive predictive values (52.4-84.6%). After adjusting for age and case severity, there was a 9.1-fold greater odds of mortality upon admission, for every increase of 500 ascitic PMNs.Conclusion: In this study of cirrhotic patients with SBP, in-hospital mortality was associated with persistently elevated ascitic PMNs. Ascites PMN thresholds offer a quick, low-tech option to risk stratify patients, prognosticate mortality, and guide patient care in low resourced settings. Journal of Advances in Internal Medicine 2015;04(01):6-12
机译：背景：肝硬化是尼泊尔住院的常见原因，自发性细菌性腹膜炎（SBP）是死亡率的主要决定因素。有限的诊断方案无法及早进行风险分层以改善患者预后。我们评估了住院SBP患者的多形核白细胞计数（PMNs）的预测价值及其与死亡率的关系。方法：我们从2010年2月至2010年2月至尼泊尔三级医疗机构接受了一项前瞻性病例对照研究，检查了51名被诊断为SBP的肝硬化患者2012年11月。在入院时，第24和48小时进行了连续的穿刺和腹水分析。接收者操作特征（ROC）曲线，方差的重复测量分析和逻辑回归分析评估了腹水PMN作为死亡率的预测指标。结果：死者的患者表现出平均循环和腹水PMN显着升高。非幸存者的腹水PMN在入院后以及24和48小时时明显升高。这些差异基于绝对计数，相对差异和跨时间的趋势是显着的。 ROC曲线提供的诊断阈值（1600、860、500个细胞/ mm3）在出现时分别在24小时和48小时时将两组区分，具有高敏感性（100％），特异性（82.5-97.5％）和阳性预测值（ 52.4-84.6％）。调整年龄和病情严重程度后，每增加500例腹水PMN，入院时的死亡率几率就提高了9.1倍。 PMN。腹水PMN阈值提供了一种快速，低技术含量的选择，可在资源贫乏的地区对患者进行分层风险，预测死亡率并指导患者护理。内科学进展杂志2015; 04（01）：6-12

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