Frequency of Spontaneous Bacterial Peritonitis In Cirrhotic Patients Presenting with Ascites in Emergency Settings
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Abstract
Background: Spontaneous bacterial peritonitis is a serious infectious complication of cirrhosis with ascites and may present with nonspecific clinical features in emergency settings, making early diagnostic paracentesis essential for timely recognition. Objective: To determine the frequency of spontaneous bacterial peritonitis among adult cirrhotic patients presenting with ascites to the emergency department of a tertiary-care hospital. Methods: This prospective observational study was conducted in the Department of Emergency Medicine, Lady Reading Hospital Medical Teaching Institution, Peshawar, from January 1, 2025, to June 30, 2025. Adult patients aged 18 years or above with established cirrhosis and clinically or ultrasonographically confirmed ascites were enrolled using consecutive non-probability sampling. Spontaneous bacterial peritonitis was diagnosed when ascitic fluid polymorphonuclear leukocyte count was ≥250 cells/mm³. Data were analyzed using SPSS version 23. Results: A total of 120 patients were included, with a mean age of 52.8 ± 11.4 years; 74 (61.7%) were male and 46 (38.3%) were female. Spontaneous bacterial peritonitis was diagnosed in 34 patients, giving a frequency of 28.3% (95% CI: 21.0–37.0). Hepatitis C virus-related cirrhosis was the most frequent etiology, present in 68 patients (56.7%). Fever was more common among patients with spontaneous bacterial peritonitis than those without it (58.8% vs 30.2%; OR 3.30, 95% CI: 1.45–7.51), and mean total leukocyte count was higher in the spontaneous bacterial peritonitis group (12.4 ± 3.2 vs 8.6 ± 2.8 ×10⁹/L). Conclusion: Spontaneous bacterial peritonitis was frequent among cirrhotic patients with ascites presenting to the emergency department, affecting more than one-quarter of the cohort. Routine early diagnostic paracentesis should be emphasized in emergency evaluation, especially among patients with fever, leukocytosis, abdominal symptoms, or hepatic encephalopathy
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