FREQUENCY OF SPONTANEOUS BACTERIAL PERITONITIS IN PATIENTS WITH FIRST PRESENTATION OF ASCITES: A MULTICENTER PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Spontaneous Bacterial Peritonitis, Ascites, First-Episode, Chronic Liver Disease, Child-Pugh, Diagnostic Paracentesis, Mortality, Prospective Study, Multicenter, Pakistan
Abstract
Ascites, commonly resulting from chronic liver disease, often complicates with spontaneous bacterial peritonitis (SBP), a life-threatening condition with high morbidity and mortality. Limited data exists on the frequency of SBP in first-episode ascites, particularly in developing countries.
Objective: To determine the frequency of SBP in patients presenting with first-episode ascites and to evaluate its association with liver disease severity and etiology.
Methods: This multicenter, prospective observational study was conducted from September 2022 to December 2024, at Bannu Medical College / Khalifa Gul Nawaz Teaching Hospital, Bannu; Muhammad College of Medicine / Muhammad Teaching Hospital; Jinnah Medical College & Teaching Hospital, Peshawar; Aga Khan University Hospital, Karachi. Adult patients (≥18 years) with newly diagnosed ascites were included. Diagnostic paracentesis was performed, and SBP was diagnosed based on a polymorphonuclear leukocyte (PMN) count of ≥250 cells/mm³, regardless of culture results. Data were analyzed using SPSS version.
Results: A total of 217 patients were enrolled. The mean age was 53.1 ± 11.4 years, and 65.4% were male. Chronic liver disease was the most common etiology (87.1%). SBP was diagnosed in 48 patients, yielding a frequency of 22.1%. SBP was significantly more common in patients with chronic liver disease-related ascites and was strongly associated with advanced liver disease, especially in Child-Pugh class C (p < 0.05).
Conclusion: SBP is common even in first-episode ascites, affecting more than one-fifth of patients. Its strong association with advanced liver disease underscores the importance of routine diagnostic paracentesis for early diagnosis and timely treatment.
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Rahid Gul
Assistant Professor Gastroenterology, Bannu Medical College / Khalifa Gul Nawaz Teaching Hospital, Bannu,
Muhammad Siddique
Muhammad College of Medicine Senior Registrar Gastroenterology Muhammad Teaching Hospital
Younas Ahmad
Assistant Professor, Jinnah Medical College & Teaching Hospital, Peshawar,
Intikhab Alam
Assistant Professor, Jinnah Medical College & Teaching Hospital, Peshawar,
Sabir Khan
Fellow Medical Officer, Aga Khan University Hospital, Karachi,
Muhammad Amjad khan
Consultant Gastroenterologist DHQ Hospital Mardan
