Dataset Information

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

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Publications

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

Simbrunner Benedikt B Röthenbacher Annika A Haslacher Helmuth H Bauer David D Chromy David D Bucsics Theresa T Schwabl Philipp P Paternostro Rafael R Scheiner Bernhard B Trauner Michael M Mandorfer Mattias M Schwarzinger Ilse I Reiberger Thomas T

United European gastroenterology journal 20190405 5

<h4>Background</h4>Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A-PMN) > 250 cells/µl.<h4>Objective</h4>We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP.<h4>Patients and methods</h4>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-P ...[more]

PMID: 31210943

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Project description:Hepatitis C virus and alcoholic liver disease are major causes of chronic liver diseases worldwide. Little is known about differences between chronic hepatitis C and alcoholic liver disease in terms of lymphocytes' sub-population. Aim of the present study was to compare the sub-populations of lymphocytes in both ascitic compartment and peripheral blood in patients with decompensated liver cirrhosis due to chronic hepatitis C and alcoholic liver disease. Patients with decompensated liver cirrhosis due to hepatitis C virus or alcoholic liver disease evaluated from April 2014 to October 2016 were enrolled. Whole blood and ascitic fluid samples were stained with monoclonal antibodies specific for human TCR??, TCR??, CD3, CD4, CD8, CD19, CCR6, CD16, CD56, CD25, HLA-DR, V?24. Sixteen patients with decompensated liver cirrhosis were recruited (9 with hepatitis C virus and 7 with alcoholic liver disease). In ascitic fluid, the percentage of both CD3+CD56- and CD3+CD56+iNKT cells resulted higher in hepatitis C virus patients than in alcoholic liver disease patients (1.82?±?0.35% vs 0.70?±?0.42% (p?<?0.001) and 1.42?±?0.35% vs 0.50?±?0.30% (p?<?0.001), respectively). Conversely, in peripheral blood samples, both CD3+CD56- and CD3+CD56+iNKT cells resulted significantly higher in alcoholic liver disease than in hepatitis C virus patients (4.70?±?2.69% vs 1.50?±?1.21% (p?<?0.01) and 3.10?±?1.76% vs 1.00?±?0.70% (p?<?0.01), respectively). Both elevation of iNKT cells in ascitic fluid and reduction in peripheral blood registered in hepatitis C virus but not in alcoholic liver disease patients might be considered indirect signals of tissutal translocation. In conclusion, we described relevant differences between the two groups. Alcoholic liver disease patients displayed lower number of CD3+CD4+ cells and a higher percentage of CD3-CD16+, V?24+CD3+CD56- and V?24+CD3+CD56+iNKT cells in ascitic fluid than hepatitis C virus positive subjects. Further studies might analyze the role of immune cells in the vulnerability toward infections and detect potential targets for new treatments especially for alcoholic liver disease patients.

Project description:BackgroundIt is difficult to diagnose ascites infection early in cirrhotic patients. The present study was to create and evaluate a new bioscore combined with PCT, sNFI and dCHC in the diagnosis of ascites infection in cirrhotic patients.MethodsTwo hundred and fifty-nine consecutive patients were enrolled; of which 51 patients were culture-positive spontaneous bacterial peritonitis (culture-positive SBP) and 58 patients were culture-negative SBP. The efficacy of procalcitonin(PCT), c-reactive protein (CRP), white blood cell (WBC), mean fluorescence intensity of mature neutrophils(sNFI) and difference in hemoglobin concentration between newly formed and mature red blood cells(dCHC) for diagnosing ascites infection was examined. These parameters were used to create a scoring system. The scoring system was analyzed by logistic regression analysis to determine which parameters were statistically different between ascites infection and non-ascites infection patients. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic ability of bioscore for ascites infection.ResultsIn ROC analysis, the area under the curves (AUC) for PCT was 0.852 (95% CI 0.803-0.921, P?<?0.001), dCHC 0.837 (95% CI 0.773-0.923, P?<?0.001), CRP 0.669 (95% CI 0.610-0.732, P?=?0.0624), sNFI 0.838 (95% CI 0.777-0.903, P?<?0.001), and WBC 0.624 (95% CI 0.500-0.722, P?=?0.0881). Multivariate analysis revealed PCT, dCHC and sNFI to be statistically significant. The combination of these three parameters in the bioscore had an AUC of 0.937 (95% CI 0.901-0.994, P?<?0.001). A bioscore of ?3.40 was considered to be statistically significant in making a positive diagnosis of ascites infection. In different groups of ascites infection, bioscore also shown a high diagnostic value of AUC was 0.947(95% CI 0.882-0.988, P?<?0.001) and 0.929 (95% CI 0.869-0.974, P?<?0.001) for culture-positive SBP and culture-negative SBP group respectively.ConclusionThe composite markers of combining PCT, dCHC and sNFI could be a valuable diagnostic score to early diagnose ascites infection in patients with cirrhosis.

Dataset Information

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

Background

Objective

Patients and methods

Results

Conclusion

Publications

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

Similar Datasets

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