Diagnosis of Spontaneous Bacterial Peritonitis in Infants and Children with Chronic Liver Disease: A Cohort Study

Overview

Journal Ital J Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2011 May 24

PMID 21599998

Citations 8

Authors

Mortada H F El-Shabrawi

Ola El-Sisi

Sawsan Okasha

Mona Isa

Sayed Abou Elmakarem

Iman Eyada

Zainab Abdel-Latif

Gamal El-Batran

Naglaa Kamal

Affiliations

Soon will be listed here.

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in infants and children with chronic liver disease (CLD); however its diagnosis might be difficult. We aimed to study the feasibility of diagnosing SBP by routine ascitic fluid tapping in infants and children with CLD.

Methods: We enrolled thirty infants and children with biopsy-proven CLD and ascites. Ascitic fluid was examined for biochemical indices, cytology and cell count. Aerobic and anaerobic bacteriological cultures of ascitic fluid were preformed. Direct smears were prepared from ascitic fluid deposit for Gram and Zheil-Nelson staining.

Results: Patients were divided into three groups: Group I included five patients with SBP in which the cell count was ≥ 250/mm3 and culture was positive (16.7%), Group II, eight patients with culture negative neutrocytic ascites (CNNA) with cells ≥ 250/mm3 and negative culture (26.7%) and Group III, seventeen negative patients (56.6%) in which cells were <250/mm3 and culture was negative. None of our patients had bacteriascites (i.e. culture positive with cells <250/mm3). Presence of fever was significantly higher in SBP and CNNA. The mean lactate dehydrogenase (LDH) level was significantly higher in ascitic fluid in the infected versus sterile cases (p < 0.002). A ratio of ascitic/serum LDH ≥ 0.5 gave a sensitivity of 80%, specificity of 88%, positive predictive value (PPV) of 66.7%, negative predictive value (NPV) of 93.7% and accuracy of 63.3%. The mean pH gradient (arterial - ascitic) was significantly higher in SBP and CNNA cases when compared to the negative cases (p < 0.001). Ascitic fluid protein level of ≤ 1 gm/dl was found in 13/30 (43.3%) of studied cases with a sensitivity of 100%, specificity of 64.7%, PPV of 45.5%, NPV of 100% and diagnostic accuracy of 53.3% (p = 0.0001).

Conclusions: SBP is a rather common complication in children with CLD. Culture of the ascitic fluid is not always diagnostic of infection. Biochemical parameters of the ascitic fluid definitely add to the diagnostic accuracy. LDH ascitic/serum ratio ≥ 0.5, an arterial-ascitic pH gradient ≥ 0.1 and total ascitic fluid protein ≤ 1 gm/dl are the most significant parameters suggesting infection.

Citing Articles

Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Salehi S, Honar N, Pouladfar G, Davoodi M, Reihani H, Haghighat M Iran J Med Sci. 2024; 49(6):369-376.

PMID: 38952643 PMC: 11214674. DOI: 10.30476/ijms.2023.98747.3082.

Multiple organ involvement and ICU considerations for the care of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in children.

Mataya L, Srinivasan V, Rand E, Alcamo A Transl Pediatr. 2021; 10(10):2749-2762.

PMID: 34765498 PMC: 8578785. DOI: 10.21037/tp-20-375.

Ascitic fluid infection in children with liver disease: time to change empirical antibiotic policy.

Singh S, Poddar U, Mishra R, Srivastava A, Yachha S Hepatol Int. 2019; 14(1):138-144.

PMID: 31290071 DOI: 10.1007/s12072-019-09968-x.

Routine analysis of ascitic fluid for evidence of infection in children with chronic liver disease: Is it mandatory?.

Ghobrial C, Mogahed E, El-Karaksy H PLoS One. 2018; 13(10):e0203808.

PMID: 30289914 PMC: 6173381. DOI: 10.1371/journal.pone.0203808.

Serum C-Reactive Protein in Children with Liver Disease and Ascites.

Kalvandi G, Honar N, Geramizadeh B, Ataollahi M, Rahmani A, Javaherizadeh H Hepat Mon. 2016; 16(8):e38973.

PMID: 27795726 PMC: 5070613. DOI: 10.5812/hepatmon.38973.

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