Brief Article
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World J Hepatol. Mar 27, 2013; 5(3): 104-108
Published online Mar 27, 2013. doi: 10.4254/wjh.v5.i3.104
Low incidence of spontaneous bacterial peritonitis in asymptomatic cirrhotic outpatients
Jean-François 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
Jean-François Cadranel, Liver, Gastroenterology and Nutrition Department, Centre Hospitalier Laennec, 60100 Creil, France
Jean-Baptiste Nousbaum, Department of Hepato-Gastroenterology, University Hospital La Cavale Blanche, 29609 Brest, France
Christophe Bessaguet, Department d'Information Médicale, Centre Hospitalier, 29000 Quimper, France
Pierre Nahon, Department of Hepato-Gastroenterology, Hôpital Jean Verdier, 93140 Bondy, France
Eric Nguyen-Khac, Department of Hepato-Gastroenterology, Amiens University Hospital, 80054 Amiens, France
Richard Moreau, Department of Hepatology, Hôpital Beaujon, 92100 Clichy, France
Thierry Thévenot, Department of Hepatology, University Hospital Jean Minjoz, 25030 Besançon, France
Christine Silvain, Department of Hepato-Gastroenterology, Poitiers University Hospital, 86000 Poitiers, France
Christophe Bureau, Department of Hepato-Gastroenterology, Purpan Hospital, 31059 Toulouse, France
Olivier Nouel, Department of Hepato-Gastroenterology, Centre Hospitalier de Saint Brieuc, 22027 Saint Brieuc, France
Christophe Pilette, Department of Hepato-Gastroenterology, Centre Hospitalier, 72037 Le Mans, France
Thierry Paupard, Department of Hepato-Gastroenterology, Centre Hospitalier de Dunkerque, 59240 Dunkerque, France
Arnaud Pauwels, Department of Hepato-Gastroenterology, Centre Hospitalier de Gonesse, 95503 Gonesse, France
Thierry Sapey, Department of Hepato-Gastroenterology, Centre Hospitalier de Chateauroux, 36000 Chateauroux, France
Jean-Didier Grangé, Department of Hepatology, Hôpital Tenon, 75020 Paris, France
Albert Tran, Digestive Center, University Hospital of Nice, 06202 Nice, France
Author contributions: Cadranel JF and Nousbaum JB equally contibuted to this work; Cadranel JF, Nousbaum JB, Silvain C, Pauwels A and Tran A designed the study; Bessaguet C analyzed the data; Cadranel JF and Nousbaum JB wrote the paper; Cadranel JF, Nousbaum JB, Nahon P, Nguyen-Khac E, Moreau R, Thévenot T, Silvain C, Bureau C, Nouel O, Pilette C, Paupard T, Pauwels A, Sapey T, Grangé JD and Tran A collected the data and approved final version of the manuscript.
Correspondence to: Jean-François Cadranel, MD, Professor CMH, Liver, Gastroenterology and Nutrition Department, Centre Hospitalier Laennec, BP 72, 60100 Creil, France. jfrancois.cadranel@ch-creil.fr
Telephone: +33-3-44616443 Fax: +33-3-44616440
Received: July 4, 2012
Revised: September 24, 2012
Accepted: November 14, 2012
Published online: March 27, 2013
Abstract

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.

Keywords: Liver cirrhosis; Ascites; Ascitic fluid; Bacterial infections; Paracentesis; Peritonitis