Risk factors for ascitic fluid infection in cirrhotic patients with variceal bleeding

Choi, Moon Seok; Lee, Joon Hyoek; Koh, Kwang Cheol; Paik, Seung Woon; Shim, Sang Goon; Kim, Chang Seop; Ryu, Kwang Hyun; Rhee, Poong Lyul; Kim, Jae Jun; Rhee, Jong Chul; Choi, Kyoo Wan

Abstract

BACKGROUND: Ascitic fluid infection is frequently associated with gastrointestinal bleeding and heralds poar prognosis in patients with liver cirrhosis. The aims of this study were to assess the incidence of ascitic fluid infection and to determine the risk factors associated with ascitic fluid infection in cirrhotic patients with variceal bleeding.
METHODS
Total 148 bleeding cirrhotic patients receiving endoscopic variceal ligation were evaluated. Characteristics of patients and bleeding were compared between the infected group (with ascitic fluid infection) and non-infected group (without ascitic fluid infection).
RESULTS
Ascitic fluid infection was detected in 22 (14.9%) of 148 patients. Child-Pugh class B or C (90.9% vs 61.9%, p<0.001), diabetes melitus (36.4% vs 12.7%, p=0.01), systolic blood pressure lower than 90 mmHg (40.9% vs 17.5%, p=0.02), active bleeding (68.1% vs 31.9%, p=0.02), transfusion of 4 pints or more (54.5% vs 20.6%, p=0.002) were more frequently found in infected group compared to non-infected group (n=126). Multivariate analysis showed that Child-Pugh class (p=0.03, R=0.21) and transfusion amount (p=0.02, R=0.34) were independent risk factors of ascitic fluid infection.
CONCLUSION
In bleeding cirrhotics with Child-Pugh class B or C or transfusion of 4 pints or more, risk for ascitic fluid infection was high and antibiotic prophylaxis should be considered.