Patients with Spontaneous Bacterial Peritonitis: PATIENTS AND METHODS
A total of 92 patients with ascites were evaluated. Biochemical and hematological investigations besides microbiological culture of the ascitic fluid were routinely done to all of the patients. Complete blood count, biochemical investigations, abdominal ultrasonography and cytologic examination of the ascitic fluid were performed. Ninety-two patients were divided to three groups according to etiology of the ascitic fluid:
1. SBP (group 1): Twenty-two patients with SBP (14 males and eight females), aged 51.5 ± 10.4 years with a previous history of chronic liver disease formed group 1. Chronic liver disease was due to hepatitis В in 17 cases and hepatitis С in five cases. According to Child-Pugh classification, 14 of the patients were group С and eight were group B. The SBP group was formed of patients either having a positive microbiological culture of the ascitic fluid or having a neutrophil count of >500/mm Ascitic fluid culture positivity was detected in 19 patients (E. coli in 12, enterecocci in five, S. aureus in two). In five patients with a fever of >38°C, the same organism was detected also in the blood (E. coli in four, S. aureus in one).
2. Chronic liver disease with sterile ascites (group 2): Thirty-two patients (20 males and 12 females) aged 54.4 ± 11.2 years formed group 2. Hepatitis В was positive in 21 and hepatitis С was positive in 11 patients. According to Child-Pugh classification, 19 patients were group C, and 13 patients were group B. Malignancy and infections was ruled out in all these patients.
3. Malignancy-induced ascites (group 3): Thirty-eight patients (24 males and 14 females) aged 52.2 ±9.1 years formed group 3. The diagnosis of malignancies was based on histopathological examination of liver, omentum and mass. These patients included nine ovarian, seven colon, six gastric, five mesothelioma, three hepatoma, two cholangiocellular, two breast, two lymphoma, one ileum and one pancreas carcinoma cases. Eight of these patients were detected to have liver metastasis by ultrasonographic biopsy.
Ascitic fluid and serum were put in polypropylene tubes and centrifuged. The supernatants were stored in -70°C.
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TNF was studied by ELISA method (Endogen, USA). TNF-r p60 level was also studied by ELISA method (Bender Med Systems, Austria). Intra- and inter-assay of coefficient of variation are 3.24% and 8.6%, respectively. The lowest values that can be determined were 10 pg/ml for TNF-a and 80 gp/ml for TNF-r. CRP was studied by turbidimetric kinetic method, and the lowest value was 0.5 mg/dl.
Microbiological cultures of ascitic fluid and blood were taken to bactec aerobic and anaerobic automatized culture mediums.
Hemogram was determined by Coulter Counter, STKS, United Kingdom. Tests of hemostasis were determined by coagulometry (ACL 5000, plus, Italy). HBs Ag was studied by Micro ELISA (Well-cozyme), and anti-HCV was determined by Macro ELISA (Abbott). Biochemical examinations of the ascitic fluid and serum was studied by autoanalyza-tor (Olympus AU 600, Japan).
Statistical analysis was done by SPSS® statistical software. Data is presented as the means ± standard deviations. Intergroup evaluations for nonparametric tests were done by Mann-Whitney U and Kruskal-Wallis 1-Way Anova tests. Correlations were determined by Spearman’s correlation test. P<0.05 was considered as statistically significant. Sensitivity and specificity of ascitic fluid CRP, TNF-a and TNF-r were also calculated.
Sensitivity was calculated as: true positive/(true positive + false negative) x 100; specificity as: true negative/(true negative + false positive) x 100.