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 

机构地区：[1]Gastroenterology and Nutrition Department, Centre Hospitalier Laennec [2]Department of Hepato-Gastroenterology, University Hospital La Cavale Blanche [3]Department d'Information Médicale, Centre Hospitalier [4]Department of Hepato-Gastroenterology, Hpital Jean Verdier [5]Department of Hepato-Gastroenterology, Amiens University Hospital [6]Department of Hepatology, Hpital Beaujon [7]Department of Hepatology, University Hospital Jean Minjoz [8]Department of Hepato-Gastroenterology, Poitiers University Hospital [9]Department of Hepato-Gastroenterology, Purpan Hospital [10]Department of Hepato-Gastroenterology, Centre Hospitalier de Saint Brieuc [11]Department of Hepato-Gastroenterology, Centre Hospitalier [12]Department of Hepato-Gastroenterology, Centre Hospitalier de Dunkerque [13]Department of Hepato-Gastroenterology, Centre Hospitalier de Gonesse [14]Department of Hepato-Gastroenterology, Centre Hospitalier de Chateauroux [15]Department of Hepatology, Hpital Tenon [16]Digestive Center, University Hospital of Nice

出　　处：《World Journal of Hepatology》2013年第3期104-108,共5页世界肝病学杂志（英文版）（电子版）

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.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 &lt; 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 &lt; 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 &lt; 0.001), Child-Pugh score was lower (8.9 vs 10.1; P &lt; 0.001) and more often B than C (63.7% vs 38%; P &lt; 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 &lt; 0.0001), and ascitic protein concentration higher (17.9 ± 10.7 g/L vs 14.5 ± 10.9 g/L; P &lt; 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.

关 键 词：Liver cirrhosis ASCITES ASCITIC fluid Bacterial infections PARACENTESIS PERITONITIS 

分 类 号：R575.2[医药卫生—消化系统]