| Spontaneous bacterial peritonitis (SBP) is an infection of ascites that occurs in the absence of a contiguous source of infection (e.g., intestinal perforation, intra-abdominal abscess). Theprevalence of SBP in hospitalized cirrhotic patients ranges between 10% and 30%. When first described, its mortality exceeded 90%; however, with early recognition of SBP has been reduced to around 20%. In patients who survive an episode of SBP, the 1-year cumulative recurrence rate is high, at about 70%. Translocation of indigenous bacteria from the gut lumen of cirrhotic animals to mesenteric lymph nodes appears to be an important step in the pathogenesis of sequence of events leading to translocation remains unclear. One of the most predictable risk factors for translocation is overgrowth of bacterial flora. Objective and methods: The aim of the present study was to assess the clinical and laboratory characteristics of SBP and the predictive factors for in-hospital mortality in cirrhotic patient. We analyzed 68 cirrhotic patients with ascites who developed an episode of SBP during a 5-year period in one university teaching hospital. The diagnosis of SBP consisting of clinical manifestation, WBC count in ascitc fluid higher than 250/ml and PMN higher than 25%, positive ascitic culture. Secondary bacterial peritonitis, tuberculosis or peritoneal carcinomatosis must be exclusived. Results: Of the 68 subjects evaluated, 53 were males and 15 females, with a mean age of 50.26±12.20 years. With respect to the etiology of the underlying liver disease, 64 patients (94.1%) had virus-related cirrhosis, four patients (5.9%) alcoholic cirrhosis. Classification according to the Child-Pugh scoring system showed that 55.9% of the patients were Child B and 33.8% Child C. The presenting symptom was fever in 55.9% of patients and abdominal pain in52.9%, abdominal distension in 23.5%. Ascetic fluid culture was positive in 15 patients (22.1%), with gram-negative bacteria being responsible for 66.7% of them (E. coli 40%) and gram-positive, mostly Enterococcus faecalis, for the rest of the cases. The number of blood white cell and prothrombin time were statistically different between patients with survival and dead (9.60±6.01 vs 18.65±9.19, t=3.139 P<0.05 and 18.00±3.68 vs 24.69±12.68, t=3.393 P<0.05. high serum total bilirubin (3.5mg/L) and PT(>0s)were independently associated with bad prognosis. Sex, age have no relation with prognosis. The more complications and the worse prognosis. Conclusions: The peak ages of spontaneous bacterial peritonitis of cirrhosis was 40-70 years old. The major etiology of cirrhosis was chronic viral hepatitis. The overall hospital mortality was 16.2%. the clinical manifestations of SBP are mild, or lack of symptoms is frequent. Diagnosis of SBP according to the count of cell in ascetic fluid and ascetic fluid culture. The white blood cell, prothrombin time, high serum total bilirubin (3.5mg/L) , PT(>20s)and complications have relation to prognosis. Child classification can help predict the prognosis. Early diagnosis and treatment is key to Spontaneous bacterial peritonitis.
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