Spontaneous bacterial peritonitis laboratory findings
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Differentiating Spontaneous bacterial peritonitis from other Diseases |
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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]
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.[1]
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 along with positive cultures confirm the diagnosis of spontaneous bacterial peritonitis.
- 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.
References
- ↑ European Association for the Study of the Liver (2010). "EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis". J Hepatol. 53 (3): 397–417. doi:10.1016/j.jhep.2010.05.004. PMID 20633946.