PREVALENCE AND PROGNOSTIC-SIGNIFICANCE OF BACTERASCITES IN CIRRHOSIS WITH ASCITES

The prevalence and prognostic significance of bacterascites (BA) were prospectively studied in 443 predominantly HBsAg-positive cirrhotic pa tients with ascites. Spontaneous bacterial peritonitis (SEP), culture- negative neutrocytic ascites (CNNA), and BA were identified in 12.4%, 8.4%, and 10.8%, respectively. Of these, 67%, 70%, and 71%, respective ly, had peritonitis-related signs or symptoms. Among patients with SEP or CNNA, the clinical and laboratory data showed no significant diffe rence between the symptomatic and asymptomatic groups. In contrast, am ong the patients with BA, the symptomatic group had significantly high er levels of serum total bilirubin and prolonged prothrombin time and significantly lower levels of ascitic fluid total protein than the asy mptomatic group. Furthermore, the clinical and laboratory data were re latively similar between patients with asymptomatic BA and those with sterile ascites. In contrast, patients with SEP, CNNA, or symptomatic BA exhibited significantly more severe degrees of liver disease and si gnificantly lower levels of ascitic fluid total protein than those wit h sterile ascites. There was no statistically significant difference b etween SEP and bacterascites regarding flora. All patients with SEP, C NNA, or symptomatic BA received antibiotic treatment immediately after paracentesis, as did six of the 14 patients with asymptomatic BA for concurrent respiratory or urinary tract infection, while the remaining eight patients with asymptomatic BA were followed clinically without treatment. Repeated paracentesis in the latter revealed no evidence of SEP or CNNA. The in-hospital mortality for sterile ascites was 22.8%, significantly lower than the 54.5% for SEP, 43.2% for CNNA, and 50% f or symptomatic BA, but similar to the 21.4% for asymptomatic BA. In co nclusion, 11% of cirrhotic patients with ascites had BA as a complicat ion. Of these, 71% were symptomatic and 29% were asymptomatic. The for mer might be an SEP variant, while the latter might represent transien t colonization of ascitic fluid with bacteria.