Ascitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites.

ABSTRACT:

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.

SUBMITTER: Simbrunner B 

PROVIDER: S-EPMC6545717 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature