الفهرس 
Chapter 1: Spontaneous Bacterial PeritonitisOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is a potentially fatal
condition, characterized by infection of ascitic fluid (AF) in the absence
of any intra-abdominal surgically treatable source of infection. It is the
most frequent and severe complication of cirrhotic ascites. SBP is a
condition that requires a high index of suspicion, rapid and accurate
diagnosis, in addition to prompt and effective therapy.
The prevalence of SBP ranges from 10% to 30% and mortality
from 10% to 32% in hospitalized patients.
Diagnosis of SBP is based on ascitic fluid polymorphonuclear
leukocytes (PMN) count ≥250/mm3 or ascitic fluid culture is
positive. Early antibiotic therapy is extremely important for the
successful treatment of SBP and reducing mortality.
Antibiotic prophylaxis in ascitic patients with variceal
hemorrhage decreases the risk of SBP.
Therefore, the development of new biomarkers to diagnose SBP
or predict the mortality is significant for improving the prognosis of
patients with SBP.
The mortality rate in SBP may be as low as 5% in patients who
receive prompt diagnosis and treatment. However, in hospitalized
patients, 1-year mortality rates may range from 50-70%. This is
usually secondary to the development of complications, such as
gastrointestinal bleeding, renal dysfunction, and worsening liver
failure. Patients with concurrent renal insufficiency have been shown
to be at a higher risk of mortality from SBP than those without
concurrent renal insufficiency.
Summary
68
Mortality from SBP may be decreasing among all subgroups
of patients because of advances in its diagnosis and treatment. The
overall mortality rate in patients with SBP may exceed 30% if the
diagnosis and treatment are delayed, but the mortality rate is less than
10% in fairly well-compensated patients with early therapy.
Our Study was prospective diagnostic accuracy test study which
was carried out on Ninety Patients selected from wards of Internal
Medicine Department of: Menoufia University Hospitals, National
Liver Institute at Shibin Al-Kum. & El Helal Health Insurance
Hospital at Shibin Al-Kum, from Abril 2020 to May 2021.
A written informed consent will be obtained from every eligible
patient. Patients will be informed about the study objectives,
methodology, risk, and benefit. The study’s protocol will be reviewed
and approved by ethics committee or audit department of Faculty of
Medicine, Menoufia University.
Our results are:
The Ascetics Fluid PMN cell count as a Diagnostic Marker for
SBP at a Cut of Point (>250 cell/ml) and Guide Prognostic for in
hospital Cirrhotic Hepatic Patients at a Mean of 402.5±199.1 and Range
of 46-900 and patient’s results divided into three subgroups according
to mortality(Low risk) 125- 250 cell/ml, (intermediate risk 250- 500
cell/ml, high risk > 500 Sensitivity 80% and Specificity 55.7 % Of
Negative Predictive Value = 93% Positive Predictive Value = 27% And
Accuracy 60%.
The Ascetics Fluid PGE2 as a Diagnostic Marker for SBP at a
mean 44.39.3 and Range of 28-58 and a Guide Prognostic for in
hospital Cirrhotic Hepatic Patients at a Mean of 34.43.2 and Range of
Summary
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28.4-38.3 and Sensitivity 93.3% and Specificity 96 % Of Negative
Predictive Value = 99% Positive Predictive Value = 82% And Accuracy
96%.
There is no significant difference between two groups as regard age
& gender and Residency.
There is no significant difference between two groups regardly
(Child p score- MELD score).
Significant difference between two groups regardly ascitic PMN
cell count and Ascitic fluid PGE2.
There is significant difference between two groups regardly PMN
cell which indicate that the higher Ascitic PMN cell count the
higher in hospital mortality rate there is significant difference
between two groups regardly Ascitic fluid PGE2 which indicate that
the lower Ascitic fluid PGE2 the higher in hospital mortality rate in
hepatic cirrhotic patient.