Aim: To develop criteria of early diagnosis of spontaneous bacterial peritonitis (SBP) in hepatic cirrhosis (HC).
Material and methods: Clinical symptoms of SBP including systemic inflammatory reaction were analysed in 286 patients. The count of polymorphonuclear neutrophils (PNL) in ascitic liquid (AL), microbiological study of the blood and AL were made. Ultrasound investigation assessed acoustic homogeneity of AL. Blood serum (BS) and AL were tested for cytokines content: interleukine-1beta, TNF-alpha, interleukine-4, transforming growth factor beta, C-reactive protein. Gas chromatography--mass spectrometry (GC-MC) estimated quantity and quality of chemical components--markers of potential infectious agents of AL.
Results: Three groups of patients were identified: group A (a classic SBP) consisted of 23 patients with clinical symptoms of SBP and PNL content > 0.25 x 10(9)/l; group B (control) consisted of 19 patients free of SBP symptoms and PNL content < 0.25 x 10(9)/l; group C (patients at risk)--18 patients with SBP symptoms and PNL content < 0.25 x 10(9)/l. Cultural test of AL was negative in all the groups. Symptoms of SIR occurred equally often in groups A and C. CRP in AL was higher (23.8 +/- 4.3 g/l) in group A than in group B (p < 0.05). CRP concentration (8.6 +/- 2.1 g/l) was higher in group C than in group B (p < 0.05). Changes in cytokine composition were similar in groups A and C. The number of chemical bacterial markers was higher in groups A and C (p < 0.005).
Conclusion: Patients of group C with SIR, elevated CRP, changed cytokine status, high content of chemical markers of AL infection by GC-MC are at high risk of SBP. Such patients need adequate and early antibacterial therapy.