Characteristics of ascitic fluid in the alcoholic cirrhotic

Abstract

A prospective study was conducted to define the characteristics of ascitic fluid in alcoholic cirrhotics with and without spontaneous bacterial peritonitis (SBP); to correlate these with findings in the peripheral blood; and to determine whether the use of counterimmunoelectrophoresis (CIE) for bacterial antigens will aid in the early diagnosis of SBP. Fifty-one alcoholic cirrhotics had simultaneous determination of their blood or serum and ascitic fluid for the following: WBC and differential count, RBC, LDH, amylase, glucose, total protein, and protein electrophoresis, CIE for pneumococcal and Klebsiella antigens, culture for aerobic and anaerobic bacteria and mycobacteria, and cytology. Of the 51 patients, 2 had SBP (4%). In the other 49 patients (54 sera and ascitic fluids), CIE was positive for pneumococcal antigen in 4/54 sera and in 3/54 ascitic fluids. The mean WBC count in the ascitic fluid was 349. In 4% the count was above 1000, in 18% between 501–1000, and in 32% between 301–500; polymorphs were >30% in 19/54 (32%). Specific gravity was >1.020 in 10/54 (22%), and ascitic fluid total protein of 3.0g/100 ml or above was noted in 24% (12/54). Mean ascitic fluid/serum ratios of total protein, albumin, and globulin were 0.31, 0.33, and 0.30 respectively, and mean ascitic fluid/serum ratios of LDH, amylase, and glucose were 0.54, 0.79, and 1.04. All cultures (except those with SBP) and cytology were negative. Our study confirmed the observation of others, that a significant number of noninfected cirrhotics have increased ascitic fluid WBC, % polymorphs, specific gravity, and total protein concentration. CIE was not helpful in the early diagnosis of SBP.