The Association of D-dimer and Spontaneous Hemorrhagic Ascites with Outcomes in Cirrhosis: a Retrospective Study
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Cirrhotic patients with hemorrhagic ascites have significant morbidity and mortality. This study aims to determine the relationship between D-dimer values and hemorrhagic ascites in cirrhotic patients and analyze its predictive value.This retrospective study screened 572 consecutive cirrhotic patients with ascites and hemorrhagic ascites (defined as red blood cells (RBC) in ascitic fluid ≥ 10,000/µL) during a 72-month period. The overall patient survival rate was measured by Kaplan-Meier analysis method. The relationship between D-dimer and hemorrhagic ascites was also examined. A multivariate Cox proportional hazard analysis was performed to assess the indepen-dent risk factors related to mortality.Both control group and hemorrhagic ascites patients had obvious hepatic dysfunction as determined by Model for End-Stage Liver Disease (MELD) scores of 6.37 ± 1.05 and 11.82 ± 2.86, respectively (p < 0.001). There was a higher prevalence of patients with significant ascites in those with spontaneous hemorrhagic ascites than in the control group (p = 0.003). There were significant differences in D-dimer levels between both groups (9.44 ± 5.11 vs. 26.83 ± 5.35, p < 0.001). Hemorrhagic ascites was significantly and positively correlated with D-dimer levels (r = 0.692, p < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.9838. Using Cox proportional hazard model for multivariate prognostic analysis, MELD, D-dimer and presence of spontaneous hemorrhagic ascites were independent predictors of 3-year mortality.Patients with hemorrhagic ascites had a significantly higher MELD score, D-dimer, and mortality than patients with ascites alone. D-dimer was associated with the appearance of hemorrhagic ascites and was found to be a marker of advanced liver disease and poor outcomes.Keywords:
D-dimer
Liver disease
Spontaneous bacterial peritonitis
Objective To study serum and ascites levels of procalcitonin(PCT) in liver cirrhotic patients with spontaneous bacterial peritonitis and their clinical significance.Methods The 71 cirrhotic patients with ascites were selected into this study among whom there were 49 patients with spontaneous bacterial peritonitis(SBP) and 22 without SBP.Serum and ascites levels of PCT were detected and compared with those of normal controls.Results Serum levels of PCT in patients with SBPand without SBP patients were significantly higher than those in normal controls(P0.01); Serum levels of PCT in patients with SBP were significantly higher than those in patients without SBP(P0.01); ascites levels of PCT in patients with SBP were significantly higher than those in patient without SBP (P0.01).Conclusion The detection of serum and ascites levels of PCT has an important value in early diagnosis and judgement of prognosis of SBP in liver cirrhosis.
Spontaneous bacterial peritonitis
Procalcitonin
Clinical Significance
Clinical judgement
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Spontaneous bacterial peritonitis
Ascitic fluid
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Spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis is a spontaneous bacterial infection of sterile ascites fluid in the absence of intra-abdominal sources of infection or malignancy. The purpose of the study is to determine the diagnostic and predictive potential of CRP in serum and ascites, as an inflammatory indicator of SBP in patients with liver cirrhosis and ascites and to compare the mean values of CRP in serum and ascites in patients with and without SBP. In this prospective-observational study were included 70 patients with cirrhosis and ascites, divided into two groups, SBP and non-SBP group. Quantitative measurement of CRP in serum and ascites was determined by immunoturbidimetric method using latex particles. The average value of CRP in serum in SBP group was 35.4 ± 29.51 mg / L, and in control non-SBP group it was lower (18.6 ± 18.71 mg/L), and this difference was statistically significant for p = 0.006132. The average value of CRP in ascites in SBP group was 7.3 ± 7.2, and in non-SBP group it was lower (2.9 ± 3.1l), with statistically significant difference of p = 0.001604. ROC analysis indicates that CRP contributes to the diagnosis of SBP with 71.0% (p = 0.003) (good predictor). Univariate analysis showed that serum CRP> 6 mg / L and CRP in ascites> 6 mg / L significantly increased the chance of SBP by seven times (Exp (B) = 7,319) and three times (Exp (B) = 3,059), respectively. Our research confirmed that serum CRP is a good predictor, significantly associated with the occurrence of SBP in patients with liver cirrhosis. Keywords: SBP, C-reactive protein, ascites, liver cirrhosis
Spontaneous bacterial peritonitis
Ascitic fluid
Univariate analysis
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Objective To analyze the clinical characteristics of spontaneous bacterial peritonitis in cirrhotic patients with ascites.Methods From June 2011 to June 2012,selected 30 cases in our hospital for treatment of patients with liver cirrhosis complicated with spontaneous bacterial peritonitis as the observed object,the establishment of the obser vation group,and the other to select the same period is not concurrent bacterial peritonitis 26 patients as a control group,the observation group and the control group patients clinical situation and treatment of various biochemical in dicators circumstances.Results After treatment,the total efficiency rate of the control group(88.5%) was significantly higher than the observation group,between the two groups with a significant difference(χ2 = 4.763,P 0.05).Observation group after treatment Na+,the TBIL higher than,ALB,PT were lower than the control group,the difference was significant(P 0.05).Conclusion Heavier cirrhotic patients with ascites and spontaneous bacterial peritonitis disease,mortalityhigh,should take positive and effective treatment measures,in order to reduce or eliminate the occurrence of the SBP.
Spontaneous bacterial peritonitis
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Objective: To evaluate, prospectively, the prevalence, outcome and recurrence of spontaneous bacterial peritonitis (SBP) in cirrhotics with ascites. Setting: Gastroenterology unit at a teaching hospital in Milan and four referring hospitals. Patients and methods: Two hundred and sixty-five consecutive cirrhotics with ascites (208 men, 57 women) were studied. Ascitic fluid tap was obtained at entry to determine total protein concentration, absolute polymorphonuclear (PMN) cell count and to allow bedside culture of both aerobic and anaerobic organisms. Statistical analysis: Mann-Whitney and χ 2 tests. Results: SBP was diagnosed in 24 patients (9%), with enteric organisms involved in 21 patients, culture-negative neutrocytic ascites (CNNA) in 34 (13%) and bacterascites (BA) in 16 (6%)
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Ascitic fluid
Microbiological culture
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Objective It is to discuss the relationship between the levels of CA125,CA199 and AFP of cirrhosis patients and ascites.Methods The levels of CA125, CA199 and AFP in serum of 217 cirrhosis patients and 50 healthy people were detected with radioimmunoassay.The levels of CA125,CA199 and AFP in ascites of 92 cases were detected at the same time.Results The CA125 levels in serum of cirrhosis patients were significantly higher than that of healthy control group,and were added by the worsened of cirrhosis.The levels of CA125 in serum of ascites patients were obviously raised,and compared with the same child classification without ascites patients,it had statistics value.With the addition of ascites quantity,the levels of CA125 in serum were upward trend.The levels of CA199 and AFP in cirrhosis patients rose slightly,but it wasn't clearly correlation with cirrhosis degree and ascites quantity.Conclusion The levels of CA125 in serum will be definitely consulting value in weighing the prognosis of cirrhosis patients and the ascites quantity.The levels of CA199 and AFP in cirrhosis patients rose slightly,but it wasn't clearly correlation with ascites quantity.
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Spontaneous bacterial peritonitis
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Background: Spontaneous bacterial peritonitis (SBP) is probably the best characterized infectious complication that develops in patients with cirrhosis and ascites. Aims and objective: The present study was done to find the incidence of SBP in patients of chronic liver disease and to find its correlation with serum ascites albumin gradient. Material and Methods: A total of 55 patients were selected for the study and divided into 2 groups; Group A - spontaneous bacterial peritonitis (SBP) and Group B -sterile cirrhotic ascites (SCA). Diagnosis was done by calculating SAAG (Serum Ascites Albumin Gradient) which reflects the differences in osmotic pressure and correlates with portal venous pressure. Total ascitic protein and ascitic -serum total protein ratio were taken as a diagnostic parameter for SBP. Results: Maximum incidence of disease was found between 31-50 years of age. Serum albumin values in SBP (2.50±0.31 gm/dl) when compared with SCA (2.85±0.39) and total ascites albumin in SBP (0.41±0.21) with SCA (0.89±0.31) were significantly different (p<0.001, t=3.59 and p<0.001, t=6.58 respectively). No significant difference (p>0.05, t=1.17) was found in serum ascites albumin gradient (SAAG), when it was compared between SBP (2.09±0.42 mg/dl) and SCA (1.96±0.37 gm/dl). Conclusion: In a patient of cirrhosis with ascites early diagnosis of development of SBP in a case of SCA can prevent mortality.
Spontaneous bacterial peritonitis
Chronic liver disease
Liver disease
Serum Albumin
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To assess objective incidence of spontaneous bacterial peritonitis (SBP), laboratory findings, effectivity of the treatment and mortality of cirrhotics with ascites and SBP.From June 1994 to June 1999 we performed 692 abdominal paracenteses in 169 cirrhotic patients (mean age 52,63 +/- 8,02 years, mean Child-Pugh score 10,41 +/- 3,02). Culture of ascitic fluid, total leucocyte and granulocyte count in ascites and total protein, albumin and cholesterol levels in ascites and serum were examinated. Diagnosis of SBP was established by criteria of Wilcox and Dismukes.SBP was found in 27 patients by 1st paracentesis (16,0 %), in the other 13 patients by repeated paracentesis (7,7 %). 51 episodes of SBP (7,4 % of all paracenteses) were found in 40 patients. 48 episodes of SBP (94,7 %) were succesfully treated by ATB therapy, 8 patients with SBP died during hospitalization (15,7 %). Patients with SBP had significant lower total protein, albumin and cholesterol levels in serum and ascites compared to patients without ascites infection (all paramethers p <0,01).SBP is a common complication in patients with advanced liver cirrhosis and ascites. Despite of effectivity of ATB therapy the hospital mortality of patients with SBP is high.liver cirrhosis, ascites, spontaneous bacterial peritonitis, mortality.
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Paracentesis
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In the study 52 patients with decompensated liver cirrhosis and "tense" ascites were included. According to the clinical picture, ascites cultures and the number of polymorphonuclears in cmm of the ascitic fluid, all patients were selected in one of the following groups: 1. group of patients with sterile ascites (28), 2. group of patients with spontaneous peritonitis (16), and 3. group of patients with bacterascites (8). The results have shown that the incidence of spontaneous peritonitis is much higher in the group of "tense" ascites patients than in the group of all patients with ascites, the ratio being 30.7% compared to 6% in all cirrhotic patients with ascites. Spontaneous bacterial peritonitis correlates with increased polymorphonuclears in the ascitic fluid (p less than 0.05), decreased pH values (p less than 0.0), and increased amounts of total proteins in the ascitic fluid (p less than 0.05). The lethality rate in the group of spontaneous peritonitis and sterile ascites was 43.7% and 7.1% respectively. Early diagnosis and, of course, adequate therapy are the main points in spontaneous bacterial peritonitis.
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