Retrospective Cohort Study
Copyright ©The Author(s) 2024.
World J Hepatol. Nov 27, 2024; 16(11): 1265-1281
Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1265
Table 1 Type of bacteria according to their pathogenicity in spontaneous bacterial peritonitis

Bacteria
Pathogenic
Staphylococcus aureus
Enterococcus faecalis
Enterococcus faecium
Escherichia coli
Klebsiella pneumoniae
Pseudomona aeruginosa
Anaerobes
Clostridium innocuum
Streptococcus gallolyticus
Streptococcus agalactie
Indeterminate
Sphingomonas paucimobilis
Acinetobacter sp.
Streptococcus sanguinis
Streptococcus parasanguinis
Streptococcus salivarius
Non-pathogenic
Staphylococcus epidermidis
Staphylococcus capitis
Staphylococcus haemolyticus
Staphylococcus hominis
Staphylococcus saprophyticus
Staphylococcus pasteuri
Staphylococcus pettenkoferi
Staphylococcus warneri
Staphylococcus saccharolyticus
Corynebacterium striatum
Corynebacterium jeikeium
Micrococcus luteus
Dermacoccus nishinomiyaensis
Kocuria rhizophilia
Table 2 Performance of automated and manual cell count methods in cohort 2 employing different cutoffs, n (%)
 
SBP
Total
Positive
Negative
Manual method cell count
Result cutoff ≥ 200 cells × 106
Positive19 (61)019
Negative1250 (100)62
Total315081
Result cutoff ≥ 250 cells × 106
Positive18 (58)018
Negative1350 (100)63
Total315081
Result cutoff ≥ 300 cells × 106
Positive18 (58)018
Negative1350 (100)63
Total315081
Automated method cell count
Result cutoff ≥ 0.1 cells × 109/L
Positive24 (89)2650
Negative325 (49)28
Total275178
Result cutoff ≥ 0.2 cells × 109/L
Positive21 (78)250
Negative649 (96)28
Total275178
Result cutoff ≥ 0.3 cells × 109/L
Positive20 (74)020
Negative751 (100)58
Total275178
Result cutoff ≥ 0.4 cells × 109/L
Positive19 (70)020
Negative851 (100)58
Total275178
Table 3 Clinical and biochemical characteristics of positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 1, n (%)/mean ± SD

Negative-SBP
(n = 132)
Positive-SBP
(n = 5)
P value
Demographic and
clinical characteristics
Male sex73 (55)3 (60)1.0
Age (years)62.1 ± 12.971.8 ± 14.20.10
Diabetes23 (21)2 (40)0.30
Betablockers40 (37)3 (60)0.61
Immunosuppression2 (2)1 (20)0.13
SBP prophylaxis26 (24)00.59
Rifaximin6 (6)01.0
Alcohol-related cirrhosis94 (71)3 (60)0.51
Main cause of admission
Infection34 (26)2 (40)0.35
Ascites62 (47)2 (40)
Jaundice9 (7)1 (20)
Encephalopathy9 (7)0
UGIB11 (8)0
AKI2 (1)0
Other15 (4)0
Admission in ITU5 (4)01.0
Shock2 (2)01.0
Hospital mortality9/85 (11)2/5 (40)0.11
Liver and renal function
Bilirubin (µmol/L)99 ± 115188 ± 2080.10
Albumin (g/L)28 ± 529 ± 40.91
INR1.5 ± 0.42.0 ± 0.50.01
Ascites-Grade 3284 (64)2 (40)0.36
Encephalopathy
Grade 0-191 (69)3 (60)0.53
Grade 2-341 (31)2 (40)
Creatinine (µmol/L)84 ± 47104 ± 560.36
Sodium (mmol/L)132 ± 6133 ± 70.99
Child-Pugh (score)10.1 ± 1.712.0 ± 1.00.02
MELD score (points)19 ± 725 ± 70.06
UKELD score (points)58 ± 561 ± 20.25
CLIF-C ACLF score (points)43.3 ± 8.453.5 ± 7.30.02
ACLF grade
No ACLF68 (57)3 (60)0.66
ACLF grade 140 (33)1 (20)
ACLF grade 2-312 (10)1 (20)
Table 4 Markers of infection and characteristics of ascitic fluid in positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 1, n (%)/mean ± SD

Negative-SBP (n = 132)
Positive-SBP (n = 5)
P value
Markers of inflammation
CRP (mg/L)42 ± 4059 ± 260.33
CRP > 5 mg/L106 (89)5 (100)1.0
Leukocyte count in serum (× 109/L)10.2 ± 6.67.5 ± 2.30.36
Neutrophil count in serum (× 109/L)7.6 ± 5.75.8 ± 1.90.50
Temperature (°C)37.0 ± 0.737.5 ± 0.30.14
Heart rate (beats per minute)91 ± 1592 ± 190.87
Respiratory rate (breaths per minute)18 ± 419 ± 10.74
Presence of SIRS33/108 (31)0/50.17
MAP (mmHg)79 ± 1689 ± 100.19
Characteristics of the ascitic fluid
Albumin (g/L)7.7 ± 4.98.5 ± 2.10.74
Auto. polymorph count (cells × 109/L)0.47 ± 1.894.76 ± 3.86< 0.001
Manual polymorph count (cells × 106/L)72 ± 2591226 ± 1706< 0.001
Table 5 Performance of automated and manual cell count methods in cohort 1, n (%)
 
Positive-SBP
Negative-SBP
Total
Manual method cell count
Test result
Positive2 (40)68
Negative3122 (95)125
Total5128133
Automated method cell count
Test result
Positive4 (80)2125
Negative1111 (84)112
Total5132137
Table 6 Clinical and biochemical characteristics of positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 2, n (%)/mean ± SD
 
Negative-SBP (n = 52)
Positive-SBP (n = 33)
P value
Demographics and clinical characteristics
Male sex21 (40)17 (52)0.37
Age (years)55.0 ± 13.560.4 ± 14.80.08
Alcohol-related cirrhosis45 (87)29 (88)0.16
Diabetes6 (12)7 (22)0.23
Betablockers16 (31)13 (41)0.48
Immunosuppression01 (3)0.38
SBP prophylaxis24 (46)5 (16)0.005
Rifaximin1 (2)8 (25)0.002
Main cause of admission
Elective LVP52 (100)
Infection17 (52)
Ascites7 (21)
Jaundice5 (15)
Encephalopathy1 (3)
UGIB1 (3)
AKI2 (6)
Admission in ITU07 (21)< 0.001
Shock07 (22)< 0.001
Hospital mortality0/5214/33 (42)< 0.001
Liver and renal function
Bilirubin (µmol/L)42 ± 27158 ± 164< 0.001
Albumin (g/L)30 ± 429 ± 50.23
INR1.3 ± 0.21.8 ± 0.7< 0.001
Ascites-Grade 3149 (94)20 (61)< 0.001
Encephalopathy
Grade 0-152 (100)17 (52)< 0.001
Grade 2-3016 (48%) 
Table 7 Markers of infection and characteristics of ascitic fluid in positive-spontaneous bacterial peritonitis and negative-spontaneous bacterial peritonitis cases in cohort 2, n (%)/mean ± SD

Negative-SBP
(n = 52)
Positive-SBP
(n = 33)
P value
Markers of inflammation
CRP (mg/L)22 ± 1757 ± 47< 0.001
CRP > 5 mg/L24 (89)30 (91)1.00
Leukocyte count in serum (× 109/L)7.3 ± 2.111.1 ± 5.1< 0.001
Neutrophil count in serum (× 109/L)5.0 ± 1.88.6 ± 4.4< 0.001
Temperature (°C)36.9 ± 0.337.1 ± 1.00.22
Heart rate (beats per minute)102 ± 16 104 ± 200.75
Respiratory rate (breaths per minute)18 ± 321 ± 50.02
Presence of SIRS 4 (13)14 (50)0.004
MAP (mmHg)84 ± 12 74 ± 170.01
Characteristics of the ascitic fluid
Albumin (g/L)8.0 ± 4.17.5 ± 5.80.61
Automated polymorph count (cells × 109/L)0.06 ± 0.06 3.27 ± 3.68< 0.001
Manual polymorph count (cells × 106/L)20 ± 22 2157 ± 4105< 0.001
Table 8 Performance of automated and manual cell count methods in cohort 2, n (%)
 
Positive-SNP
Negative-SNP
Total
Manual method cell count
Test result
Positive18 (58)018
Negative1350 (100)63
Total315081
Automated method cell count
Test result
Positive21 (78)223
Negative649 (96)55
Total275178
Table 9 Performance of automated and manual cell count methods in cases having both methods performed in cohort 2, n (%)
 
Automated method
Total
Positive
Negative
Positive-SBP cases   
Manual method
Positive13013 (52)
Negative7512
Total20 (80)525
Negative-SBP cases
Manual method
Positive000
Negative24749 (100)
Total047 (96)49
Table 10 Performance of automated and manual cell count methods, both with cutoff PMN ≥ 200 cells/mm3 in cases having both methods performed in cohort 2, n (%)

Automated method
Total
Positive
Negative
Positive-SBP cases
Manual method
Positive14014 (56)
Negative6511
Total20 (80)525
Negative-SBP cases
Manual method
Positive000
Negative24749 (100)
Total247 (96)49
Table 11 Microbiological characteristics of positive-spontaneous bacterial peritonitis cases, n (%)

Positive-SBP (n = 33)
Origin of infection
Community-acquired18 (55)
Healthcare-associated11 (33)
Nosocomial4 (12)
Cultures
Blood or urine culture taken22 (67)
Blood or urine culture, same bacteria8 (24)
Bacteria isolated
E. coli18 (55)
Enterococcus faecium8 (24)
Enterococcus faecalis3 (9)
Klebsiella pneumoniae1 (3)
S aureus1 (3)
Streptococcus agalactie1 (3)
Clostridium innocuum1 (3)
Empirical antibiotic used
Piperacillin/tazobactam15 (46)
meropenem6 (18)
Levofloxacin4 (12)
Co-amoxiclav4 (12)
Teicoplanin2 (6)
Tigecycline1 (3)
Flucoxacillin1 (3)