Correlation of Clinically-Suspected Spontaneous Bacterial Peritonitis (SBP) With Laboratory-Confirmed SBP in Portosystemic Encephalopathy Patients

Background: Spontaneous bacterial peritonitis (SBP) is among the most common complications of liver cirrhosis with ascites. In the past, it was considered a potentially incurable disease, but its prognosis, though still quite poor, has much improved in the past few years. This has become possible due to early diagnosis and prompt treatment of this once-incurable complication of ascites. The main aim of this study was to know the relation between clinically suspected SBP and laboratory-confirmed SBP so that in the absence or delay in the more accurate diagnostic facilities, clinicians can start the treatment promptly based on diagnostically significant clinical findings while awaiting the most accurate diagnostic tests. Material and methods: This study was done at the Department of Gastroenterology, Hayatabad Medical Complex, Peshawar. After ethical approval, 186 patients with classical features of SBP i.e., fever and abdominal pain and/or tenderness (clinically SBP patients), and 104 patients without these features (clinically non-SBP patients) were studied for ascitic fluid neutrophils count, as a diagnostic test for SBP. Results: Out of 186 patients with clinically suspected SBP, 171 (91.9%) patients had laboratory-confirmed SBP and 15 (8.1%) had no SBP. Among 104 clinically non-SBP patients, 90 (86.5%) had laboratory-confirmed non-SBP, while 14 (13.5%) had SBP in laboratory studies. The sensitivity, specificity, positive predictive value, and negative predictive value of the clinical features in diagnosing SBP were 92%, 86%, 92%, and 87% respectively. Conclusion: Clinical features diagnostic for SBP can play a vital role in early diagnosis and hence requires prompt treatment in circumstances where diagnostic laboratory tests are not available and/or are delayed.