MALIGNANCY-RELATED ASCITES - A DIAGNOSTIC PITFALL OF SPONTANEOUS BACTERIAL PERITONITIS BY ASCITIC FLUID POLYMORPHONUCLEAR CELL COUNT

To define patients with an ascitic fluid polymorphonuclear cell count greater than or equal to 250 cells/mm(3) or greater than or equal to 5 00 cells/mm(3) but without spontaneous bacterial peritonitis, 166 pati ents with sterile cirrhotic ascites, 46 patients with spontaneous bact erial peritonitis, 123 patients with hepatocellular carcinoma, 67 pati ents with peritoneal carcinomatosis or massive liver metastasis and 12 patients with other miscellaneous diseases were studied. The sensitiv ity, specificity ana accuracy of the diagnosis of spontaneous bacteria l peritonitis were 100, 86 and 88% with the cut-off value of an asciti c fluid polymorphonuclear cell count greater than or equal to 250 cell s/mm(3); and were 93, 91 and 92% with that value greater than or equal to 500 cells/mm(3), respectively. With the cut-off value greater than or equal to 250 cells/mm(3) or greater than or equal to 500 cells/mm( 3), the prevalence was 18% or 14% in hepatocellular carcinoma; and 30% or 19% in peritoneal carcinomatosis or massive liver metastasis. The ascitic fluid lactate concentration was insensitive and nonspecific. A mong the patients with an ascitic fluid polymorphonuclear cell count g reater than the cut-off values, an ascitic fluid erythrocyte count gre ater than or equal to 10000 cells/mm(3), a ratio of ascitic fluid eryt hrocyte to total leukocyte count greater than or equal to 100, and the ratio of ascitic fluid polymorphonuclear cell to total leukocyte coun t less than or equal to 75% indicated hepatocellular carcinoma, while serum to ascites albumin gradient less than or equal to 1.1 g/dl and a ratio of ascitic fluid polymorphonuclear cell to total leukocyte coun t less than or equal to 75% indicated peritoneal carcinomatosis or mas sive liver metastasis. (C) Journal of Hepatology.