IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 01 Ver. X January. (2018), PP 17-32 www.iosrjournals.org DOI: 10.9790/0853-1701101732 www.iosrjournals.org 17 | Page A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites with Special Reference to Serial Ascitic Fluid Cell Count as Prognostic Marker Dr. Sushanth Vemuganti 1 ; Dr.M. K.Sagar 2 ; Dr.S.C.Mohapatra 3 ; Dr. P. Satya Raju 4 ; Dr. S. Prasanna Kumar 5 , Dr. K. S. Roshni 6 . 1 Dr. Sushanth Vemuganti, Junior Resident, General Medicine, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist, AP, India. 2 Dr.M. K. Sagar, M.D., General Medicine, Professor, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist,AP, India. 3 Dr.S.C.Mohapatra M.D., General Medicine, Professor & HOD, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist, AP, India. 4 Dr.P. Satya Raju, General Medicine, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist, AP, India. 5 Dr. S. Prasanna Kumar, , Junior Resident, General Medicine, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist, AP, India. 6 Dr. K. S. Roshni, Junior Resident, General Medicine, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram Dist,AP, India. Correspondence Author: Dr. Sushanth Vemuganti Abstract: Aim: To study clinical features and prognostic significance of various clinical, biochemical parameters and serial ascitic fluid cell count in SBP.. Study design: Prospective, observational, single centre, non-blind (open label). Place and duration of study: General Medicine Department, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Vizianagaram Dist, India from October 2014 to September 2016. Methodology: 50 patients admitted to MIMS General Hospital, Nellimarla, diagnosed as cirrhosis of liver with SBP were studied. SBP was diagnosed based on ascetic fluid cell PMN count of > 250. Serial ascitic fluid cell count was done at 0 hour, 24 hours, 48 hours, and at 5 days. The results were compared between the survivors and non-survivors and subjected to appropriate statistical analysis.. Results: Male:Female ratio in SBP patients was 2:1. Mean age at the time of diagnosis was 53.68 +/- 9.06 years (37 – 75 years). Common clinical features were - jaundice(64 %), fever(56 %), abdomen pain(56 %), altered sensorium(40%), haemetemesis or malena (36 %) and oliguria(32 %), icterus (84 %), asterixis (48 %), hypotension (24 %), abdominal tenderness (68%).Ascitic fluid culture did not show any growth in 48 % of cases while 24 % showed E. Coli, 20 % showed klebsiella, and 4 % each of proteus and staphylococcus aureus. Outcome was grave with 44 % mortality. Conclusion: : TLC above 11,000/mm3, total bilirubin above > 5mg/dl and sr. creatinine > 1.5 were associated with increased mortality. An ascetic fluid PMN count of > 600 at time of diagnosis, > 700 at 24 hours and > 450 at 48hours was associated with poor prognosis. A progressive fall in serial ascitic fluid cell PMN count was associated with good prognosis. Key Words: SBP and serial ascitic fluid cell count. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 03-01-2018 Date of acceptance: 22-01-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Cirrhosis of liver is the common hepatic disorder seen in day to day clinical practice. The mortality in cirrhosis patients mainly because of the complications like hepatic encephalopathy and spontaneous bacterial peritonitis. One of the factors which are responsible for subsequent deterioration in the condition of cirrhosis patient is appearance of spontaneous bacterial peritonitis (SBP). Spontaneous bacterial peritonitis is most common life-threatening, infectious complication in patients with ascites characterized by abrupt onset of fever, chills, abdominal pain with rebound tenderness over abdomen, absent bowel sounds and leucocytosis. Paracentesis reveals cloudy ascitic fluid with many WBCs predominantly, polymorphonuclear cells (PMN). SBP is defined as the infection of previously sterile ascitic fluid without an apparent intra-abdominal source of