Ascitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites
Background Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A PMN) 250 cells/ul. Objective We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP. Patients and methods A total of 178 patients were included and stratified by ascitic cell counts at index paracentesis: A LEUK low <250/ul) A LEUK intermediate (250 500/ul) and A LEUK SBP >500/ul) for leukocytes; A PMN low <125/ul) A PMN intermediate (125 250/ul) and A PMN SBP >250/ul) for PMN cells. Results One year mortality was comparable between group A LEUK SBP (53.9% and patients with subclinical cell counts (34.5% for A LEUK low, 43.5% for A LEUK intermediate, log rank p 0.547) However, we observed an increase in one year mortality already in group A PMN intermediate with 75% and A PMN SBP with 80.9% (vs 40.5% for A PMN low, log rank p 0.016) Importantly, increases of A PMN cell counts between two paracenteses were associated with increased mortality: per 100 cells/ul increase of absolute A PMN cell count: hazard ratio (HR) 1.03 (95% confidence interval (CI) 1.01 1.06) p 0.005; per 5% increase of relative PMN cell count: HR: 1.15 (95% CI: 1.06 1.26) p 0.001. Conclusion Patients with PMN cell counts of 125 250/ul are at high risk for mortality, which was very similar to SBP patients with PMN cell counts >250/ul. This highlights the need for preventive strategies. The prognostic value of changes in relative ascitic PMN cell counts should be evaluated in future studies.
United European gastroenterology journal