A Study of Etiology, Clinical Profile and Prognostic Factors in Ascites Patients Having Spontaneous Bacterial Peritonitis.

Abstract

Ascites is the most common complication of cirrhosis. Approximately 60% of patients with compensated cirrhosis develops ascites within 10 years during the course of their disease. Spontaneous bacterial peritonitis (SBP) is a very common bacterial infection in patients with cirrhosis and ascites. It is one of the severe complications and adverse prognostic sign of cirrhosis of liver. The important issues in SBP as a clinical entity include the clinical presentation, diagnosis, risk factors, and management.

This study was conducted in a tertiary care teaching hospital in Western Maharashtra to evaluate association between aetiology, clinical profile and prognostic factors in ascites patients having SBP. A prospective study was performed on 100 patients of ascites out of which 68 were males and 32 were females. After admission all patients were interviewed and detailed history and complete physical examination was performed. In this study, the cause of ascites was cirrhosis of liver 85 (85%), cardiac 10 (10%), hypoproteinemia 3 (3%) and lastly nephrogenic 2(2%). The cause of cirrhosis of liver was - alcohol- 41 (48.23%), post-hepatitic- 37 (43.53%) and other causes (biliary, cardiac, metabolic, drug related)- 07. The commonest clinical features were jaundice - 13 (86.7%), fever - 13 (86.7%), abdominal pain - 12 (80%) followed by abdominal tenderness - 11 (73.4%), sluggish bowel sounds (ileus) - 10 (66.7%) and hepatic encephalopathy - 9 (60%). History of fever, abdominal pain, jaundice, hepatic encephalopathy, leucocytosis in blood, raised serum bilirubin (>3.2 mg/dl), low ascitic fluid pH (< 7.30), low ascitic fluid proteins (< 1 gm/dl), increased blood urea level (> 40 mg/dl) and increased serum creatinine level (> 1 .7 mg/dl) are the factors found to be associated with increased mortality and poor prognosis in patients of SBP.