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Ascitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites
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DOI：10.1177/2050640619843000.png)
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Abstract
En 中文
Background Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A-PMN) > 250 cells/mu l. Objective We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP. Patients and methods A total of 178 patients were included and stratified by ascitic cell counts at index paracentesis: A-LEUK-low (<250/mu l), A-LEUK-intermediate (250-500/mu l) and A-LEUK-SBP (>500/mu l) for leukocytes; A-PMN-low (<125/mu l), A-PMN-intermediate (125-250/mu l) and A-PMN-SBP (>250/mu l) for PMN cells. Results One-year mortality was comparable between group A-LEUK-SBP (53.9%) and patients with subclinical cell counts (34.5% for A-LEUK-low, 43.5% for A-LEUK-intermediate, log-rank p = 0.547). However, we observed an increase in one-year mortality already in group A-PMN-intermediate with 75% and A-PMN-SBP with 80.9% (vs 40.5% for A-PMN-low, log-rank p = 0.016). Importantly, increases of A-PMN cell counts between two paracenteses were associated with increased mortality: per 100 cells/mu l increase of absolute A-PMN cell count: hazard ratio (HR): 1.03 (95% confidence interval (CI): 1.01-1.06), p = 0.005; per 5% increase of relative PMN cell count: HR: 1.15 (95% CI: 1.06-1.26), p = 0.001. Conclusion Patients with PMN cell counts of 125-250/mu l are at high risk for mortality, which was very similar to SBP patients with PMN cell counts >250/mu l. This highlights the need for preventive strategies. The prognostic value of changes in relative ascitic PMN cell counts should be evaluated in future studies.
Keywords:
Ascites
cirrhosis
mortality
polymorphonuclear cells
spontaneous bacterial peritonitis
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