Spontaneous bacterial peritonitis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Guillermo Rodriguez Nava, M.D. [3]

Overview

Diagnosis requires paracentesis (needle drainage of the ascitic fluid). Ascites culture is negative in up to 60% of patients with clinical manifestations of spontaneous bacterial peritonitis (SBP), therefore, the diagnosis is based on the neutrophil count, which reaches its highest sensitivity with a cutoff neutrophil count of > 250/mm³.

Laboratory Findings

Laboratory tests, most importantly ascitic fluid analysis is required for confirmation of diagnosis of spontaneous bacterial peritonitis.

• Complete blood count and differential count are tested to confirm infection.
• Serum electrolytes and creatinine to asses the renal function.
• Liver function tests are to performed for evaluation of cirrhosis.
• Blood cultures may be useful in sepsis
• Urine culture to rule out asymptomatic bacteriuria

Ascitic Fluid Analysis

• Absoulte neutrophil count - a total count of >250 cells/mm³ confirm the diagnosis of spontaneous bacterial peritonitis.
• When culture is positive, the most common organisms are Gram-negative bacteria (mainly Escherichia coli) and Gram-positive cocci (usually Streptococcus spp. and enterococci).
• Some patients may have an ascitic neutrophil count <250 cells/mm³ with positive cultures. This is known as "bacterascites. This patients should undergo a second [[[paracentesis]]. Patients with signs of Systemic inflammatory response syndrome (SIRS) or in whom the repeat ascitic neutrophil count is >250 cells/mm³ should receive antibiotic therapy, if not, the should be followed up.<ref name="pmid8228129">{{cite journal| author=Caly WR, Strauss E| title=A prospective study of bacterial infections in patients with cirrhosis. | journal=J Hepatol | year= 1993 | volume= 18 | issue= 3 | pages= 353-8 | pmid=8228129 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?
• Albumin concentration - it is important for the calculation of serum-ascites albumin gradient , this helps us in identifying the portal hypertension and prognosis.
• Protein concentration - low protein concentration is noticed in cases of spontaneous bacterial peritonitis which differentiates it from secondary bacterial peritonitis where it is normal.

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