Prevalence and Risk Factors for Unsuspected Spontaneous Ascitic Fluid Infection in Cirrhotics Undergoing Therapeutic Paracentesis in an Outpatient Clinic
Authors: Omar Khan Muhammad , Ikram Shah Muhammad , Imran Muhammad , Siddiq Shazia , Kumar Narindar , Shaheen Ghazala 
Published: January 2022

Background and Aim: Ascites is a common complication of liver cirrhosis, making patients more vulnerable to infectious diseases such as spontaneous bacterial peritonitis. There hasn't been much research done on infectious ascitic fluid in asymptomatic patients. The purpose of the study was to find out the infectious asymptomatic ascitic fluid incidence and risk factors in liver cirrhotic patients. Materials and Methods: This cross-sectional study was conducted on 76 cirrhotic patients who underwent therapeutic paracentesis between September 2020 and February 2021 in an outpatient department of Jinnah Medical College, Peshawar. An 18-G catheter was used to collect ascitic fluid under strict aseptic conditions. Total and differential leucocyte counts, as well as total protein and albumin levels, were measured. The fluid was injected for bacterial culture of aerobic type and anaerobic blood culture bottles (10 mL each) under strict aseptic conditions. Individuals with abdominal pain, recent gastrointestinal bleeding, fever, SBP previous history, hepatic encephalopathy, impaired renal function, and treatment with antibodies were excluded. Written informed consent and ethical approval were taken prior to study conduction. Demographic details, liver disease severity, and etiology were noted along with laboratory technique-based biochemical tests, ascitic fluid count, and culture. SPSS version 20 was used for data analysis. Results: A total of 192 paracenteses were done on 76 liver cirrhosis patients with an average of 2.53 per patient. The overall mean age was 43.65±8.7 years. Of the total 76 patients, 55 (72.4%) were male and 21 (27.6%) were female. The ascites duration for study inclusion was 3 to12 months. Hepatitis B, fatty liver disease, hepatitis C, and drugs were the major causes of cirrhosis among study patients. The prevalence of Hepatitis B, fatty liver disease, hepatitis C, and drugs was 27 (35.5), 23 (30.3%), 11 (14.5%), and 15 (19.7%) respectively. The hepatic encephalopathy and variceal bleeding history were present in 16 (33.3%) and 32 (66.7%) respectively in a total of 48 (63.2%) cirrhosis patients. The class C and child Pugh class had 23 (30.3%) and 53 (69.7%) respectively. Null mortality was found in patients due to infection caused by spontaneous ascitic fluid. Conclusion: Our study found that hepatitis B, fatty liver disease, hepatitis C, and drugs were the major causes of cirrhosis. Asymptomatic ascitic fluid infection was extremely rare in cirrhotic patients who attended an outpatient clinic and underwent therapeutic paracentesis. Additionally, our study found that the peritoneal fluid asymptomatic spontaneous infection is rare among cirrhotic patients undergoing outpatient base therapeutic paracentesis. Further investigation for ascitic fluid analysis's role in such infection without treatment is to be carried out. Keywords: Ascitic fluid; Cirrhosis; Infection; Therapeutic paracentesis; Spontaneous bacterial peritonitis