PREVALENCE OF PERITONITIS AND THE ASCITIC FLUID PROTEIN-CONCENTRATIONAMONG CHRONIC LIVER-DISEASE PATIENTS

The prevalence of spontaneous bacterial peritonitis (SBP) or its varia nts, bacterascites (BA), and culture-negative neutrocytic ascites (CNN A), may vary depending on the underlying liver disease and protein con tent of ascites. In this study, we compared the frequency of peritonit is (SBP, BA, CNNA) upon admission in alcoholic (ALD), cholestatic (CLD ), and hepatocellular liver disease (HLD); determined the relationship between Child's class and prevalence of peritonitis; and assessed asc itic total protein as a risk factor for peritonitis. Between January 1 989 and April 1991, 113 consecutive patients were admitted with chroni c liver disease and ascites (49, ALD; 22, CLD; and 42, HLD). All had a dmission paracentesis. SBP was defined as polymorphonuclear cell count (PMN) greater-than-or-equal-to 250 mm3 with a positive culture, BA as PMN <250/mM3 and positive culture, and CNNA as PMN greater-than-or-eq ual-to 250/mm3 with negative culture. No patients with obvious intraab dominal source for infection (ie., secondary peritonitis) were include d in the analysis. The prevalence of peritonitis was 8/113 (7%); four patients had SBP, one BA, and three CNNA. The occurrence of peritoniti s was independent of the type of liver disease (ALD, 8%; CLD, 9%; HDL, 5%). Neither ascitic fluid total protein nor the severity of liver di sease (Child's class) predicted the occurrence of peritonitis. We conc lude that the occurrence of peritonitis is unrelated to the type of li ver disease, and severity of liver disease did not predict the presenc e of peritonitis. Also, ascitic fluid total protein <1.0 g/dl may not be a sensitive predictor of risk of peritonitis.