JUSTIFICATION OF ROUTINE ASCITES PUNCTURE IN CIRRHOTIC-PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT

Objectives: Spontaneous bacterial peritonitis (SBP) is a frequent, ser ious, recurrent complication, occuring in 10 to 30% of cirrhotic patie nts hospitalized with ascites. The key to diagnosis of SBP is ascites paracentesis and polymorphonuclear count in ascitic fluid. The purpose of our study was to evaluate sensitivity and specificity of clinical and biological criteria in diagnosis of 5 BP. Methods: We prospectivel y reviewed 30 adult cirrhotic patients admitted in our emergency depar tment with ascites. Ascites paracentesis was performed in each patient , and SBP diagnosis was based on either positive bacteriological cultu re or polymorphonuclear count above 250/mm(3) in ascitic fluid. Classi cal criteria for SBP were recorded: blood pressure under 90 mm of Hg, abdominal pain, temperature above 385 degrees or under 365 degrees, ja undice, encephalopathy, increased serum bilirubin or creatinine, leuko cyte blood count above 12 G/I. We evaluated sensitivity and specificit y of those criteria in SBP, and compared their frequency in patients w ith SBP or sterile ascitic fluid. Results: Thirty patients were includ ed in our series, and in 14 of them a SBP was diagnosed. A significant difference was observed between spontaneous bacterial peritonitis and sterile ascitic fluid for abdominal pain and temperature abnormalitie s, but specificity and sensitivity of these criteria were very low. Mo reover, SBP was asymptomatic in 7%. Conclusion: Due to the high rate o f mortality in patients with SBP we recommend diagnostic procedures fo r this frequent complication as soon as patient is admitted in emergen cy department. This diagnosis must be based on ascitic fluid paracente sis, which has to be performed, in the emergency department, in every cirrhotic patient admitted with ascites. Indeed, SBP is often asymptom atic, and no clinical or bacteriological criteria can be considered as completely reliable for the diagnosis of spontaneous bacterial perito nitis.