Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients

作     者：Jean-Franois Cadranel Jean-Baptiste Nousbaum Christophe Bessaguet Pierre Nahon Eric Nguyen-Khac Richard Moreau Thierry Thévenot Christine Silvain Christophe Bureau Olivier Nouel Christophe Pilette Thierry Paupard Arnaud Pauwels Thierry Sapey Jean-Didier Grangé Albert Tran 

作者机构：Gastroenterology and Nutrition Department Centre Hospitalier Laennec Department of Hepato-Gastroenterology University Hospital La Cavale Blanche Department d'Information Médicale Centre Hospitalier Department of Hepato-Gastroenterology Hpital Jean Verdier Department of Hepato-Gastroenterology Amiens University Hospital Department of Hepatology Hpital Beaujon Department of Hepatology University Hospital Jean Minjoz Department of Hepato-Gastroenterology Poitiers University Hospital Department of Hepato-Gastroenterology Purpan Hospital Department of Hepato-Gastroenterology Centre Hospitalier de Saint Brieuc Department of Hepato-Gastroenterology Centre Hospitalier Department of Hepato-Gastroenterology Centre Hospitalier de Dunkerque Department of Hepato-Gastroenterology Centre Hospitalier de Gonesse Department of Hepato-Gastroenterology Centre Hospitalier de Chateauroux Department of Hepatology Hpital Tenon Digestive Center University Hospital of Nice 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2013年第5卷第3期

页      面：104-108页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：LFB Laboratories 

主　　题：Liver cirrhosis Ascites Ascitic fluid Bacterial infections Paracentesis Peritonitis 

摘      要：AIM: To compare the incidence of spontaneous bacterial peritonitis in cirrhotic outpatients and inpatients undergoing therapeutic paracentesis METHODS: From January 1 to May 31, 2004, 1041 patients from 70 different hospitals underwent 2123 therapeutic abdominal paracentesis (AP) performed as a outpatient procedure in 355 and as inpatient procedure in 686 cases respectively. The following parameters were compared prospectively between outpatients and inpatients: spontaneous bacterial peritonitis (SBP) prevalence, age, gender, cause of cirrhosis, symptoms, score and grade according to Child-Pugh classification, cirrhosis complications, antibiotics treatment, serum creatinine, platelet count and ascitic protein concentration. RESULTS: SBP was observed in 91 patients. In the whole population the SBP prevalence was 8.7% (95%CI: 7.2-10.6) it was 11.7% (95%CI: 9.5-14.3) in inpatients and 3.1% (95%CI: 1.7-5.5) in outpatients (P 0.00001). SBP prevalence was 8.3% (95%CI: 4.3-15.6) in symptomatic outpatients vs 1.2% (95%CI: 0.4-3.4) in asymptomatic outpatients (P 0.002). Patients undergoing outpatient AP were significantly different from those undergoing inpatient AP; they were older (61.1 ± 11.1 years vs 59.4 ± 11.7 years; P = 0.028), cause of cirrhosis was less often alcohol (83 .7 vs 88.2%; P 0.001), Child-Pugh score was lower (8.9 vs 10.1; P 0.001) and more often B than C (63.7% vs 38%; P 0.001). In addition, in outpatients the platelet count was higher (161 ± 93 Giga/L vs 143 ± 89 Giga/L; P = 0.003), serum total bilirubin concentration was lower (38.2 ± 60.7 μmol/L vs 96.3 ± 143.3 μmol/L; P 0.0001), and ascitic protein concentration higher (17.9 ± 10.7 g/L vs 14.5 ± 10.9 g/L; P 0.001) than in inpatients. CONCLUSION: In asymptomatic cirrhotic outpatients, the incidence of spontaneous bacterial peritonitis is low thus exploratory paracentesis could be avoided in these patients without significant risk.