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Scoring system predicts spontaneous bacterial peritonitis in cirrhotic ascites

The Scandanavian Journal of Gastroenterology predicts spontaneous bacterial peritonitis in cirrhotic ascites by the use of a simple scoring system.

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Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with liver cirrhosis.

Dr Stefan Lüth and colleagues from Germany identified predictors of spontaneous bacterial peritonitis in order to develop a noninvasive method to identify or exclude an episode of spontaneous bacterial peritonitis.

The team screened 392 consecutive patients, who underwent paracentesis from 2008 through 2012 due to cirrhotic ascites.

The researchers excluded 96 patients, mostly due to prior application of antibiotics.

SBP was defined by an absolute neutrophil count ≥250 cells/µL ascites.

The research team evaluated various clinical and laboratory parameters as potential predictors of spontaneous bacterial peritonitis.

26% of patients in the training set suffered from spontaneous bacterial peritonitis
Scandanavian Journal of Gastroenterology

A scoring system was developed in a training set of 220 and validated in a second set of 76 patients.

The team noted that 26% of patients in the training set, and 22% of patients in the validation set suffered from spontaneous bacterial peritonitis.

Thrombocytopenia ≤100,000 cells/µL, age >60 years and CRP >60 mg/L were identified as independent predictors of spontaneous bacterial peritonitis.

The team found that a scoring system combining these 3 parameters reaches a positive predictive value for the diagnosis of spontaneous bacterial peritonitis of 82% with a specificity of 99%.

The research team found that the negative predictive value at a threshold of 1 point is 94% with a sensitivity of 88%.

Notably, a high MELD score is not associated with spontaneous bacterial peritonitis.

Dr Lüth's team concludes, "Combination of age, CRP and platelet count in a simple scoring system helps in the rapid diagnosis or exclusion of spontaneous bacterial peritonitis."

Scand J Gastroenterol 2014: 49(5): 595-603
15 May 2014

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