Low ascitic fluid total protein levels is not associated to the development of spontaneous bacterial peritonitis in a cohort of 274 patients with cirrhosis

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a complication to decompensated cirrhosis. Fluoroquinolones may prevent SBP. However, predictive markers for SBP are wanted. Guidelines suggest that patients with ascitic fluid protein below 15 g/l receive fluoroquinolones to prevent SBP. This study aimed to assess the clinical utility of low ascitic fluid protein in predicting SBP in patients with cirrhosis and ascites.

Methods: A total of 274 patients with cirrhosis and ascites underwent paracentesis between January 2010 and June 2015. Patients were followed until two years, development of SBP, initiation of ciprofloxacin, death or liver transplantation. Data were compared between groups of patients with ‘high’ or ‘low’ ascitic protein.

Results: SBP developed in 31 patients (11.3%). No difference in mean ascitic fluid protein levels were found (SBP, mean: 8.5 g/l and no SBP 8.2 g/l, p = .825). SBP developed at equal rates in patients with ‘high’ or ‘low’ ascitic protein (10.8% (≤15 g/l) and 14.0% (>15 g/l), p = .599). The same trend was observed when adjusting the threshold below 10 g/l (11.9% (≤10 g/l) and 10.2% (>10 g/l), p = .697).

Conclusions: Low ascitic fluid protein does not predict SBP in patients with cirrhosis and ascites. Better markers are needed.

Keywords:

• Ascites
• ascitic fluid protein
• fluoroquinolone prophylaxis
• liver cirrhosis
• spontaneous bacterial peritonitis

Acknowledgements

The authors wish to thank S⊘ren Neermark for his assistance in extracting data sheets from computerised clinical programmes and identifying patients.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Professor Flemming Bendtsen (FB) received a grant from Novo Nordisk Foundation in relation to this study. The extraction and storage of patient data was conducted in accordance with the Danish Act on Processing of Personal Data, and the study protocol was approved by the Data Protection Agency (journal no: 03934 ID-no.: AHH-2015-054) and the Danish Health and Medicines Authority (ref. no. 3-3013-1161/1/).