Impact of ascitic fluid polymorphonuclear cell counts on development of spontaneous bacterial peritonitis in patients with cirrhosis and ascites: A prospective observational study.

BACKGROUND: Knowledge about clinical implications of non-spontaneous bacterial peritonitis (non-SBP) cirrhotic patients defined by ascitic fluid PMN (A-PMN) counts <250 cells/μL is limited. The aim of this study was to determine the development of SBP in non-SBP cirrhotic patients with high A-PMN counts and compare it with low A-PMN count. METHODS: In this prospective observational study, cirrhotic patients with ascites were stratified into three categories based on A-PMN counts: 1) SBP group (PMN ≥250 cells/μL, n = 25), 2) Intermediate A-PMN group (I-PMN) (PMN counts: 60-249 cells/μL, n = 50), and 3) Low A-PMN group (L-PMN) (PMN counts ≤60 cells/μL, n = 81). All patients were followed periodically up to 6 months for development of SBP. RESULTS: All the demographic profiles of patients including CTP and MELD-Na scores were similar among all the three groups. Eleven patients (44%) in SBP and five patients (10%) in the I-PMN group developed SBP, whereas none of the patients in the L-PMN group developed SBP ( P < 0.001). A-PMN counts ( P = 0.02) were found to be significantly correlated with follow-up development of SBP. APMN counts ≥171 cells/μL predicted the development of SBP with 87.5% sensitivity and 87.9% specificity. The 6 months mortalities in I-PMN and L-PMN groups were comparable. The rehospitalization rate in I-PMN is significantly higher than that in L-PMN. CONCLUSION: Patients of the I-PMN group are associated with a significantly higher rate of development of SBP at month 6 as compared to the L-PMN group.