Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Clin Transl Gastroenterol. 2023 Sep 1;14(9):e00614. doi: 10.14309/ctg.0000000000000614.
Absolute polymorphonuclear leukocyte (PMN) count (PMN-C) ≥250 cells/mm 3 in ascites is the diagnostic hallmark of spontaneous bacterial peritonitis (SBP) and is associated with high morbidity and mortality. However, the clinical significance of ascitic PMN percentage (PMN-%) and PMN-C in the absence of SBP as additional biomarkers for mortality and future incidence of SBP has not been determined.
This retrospective cohort included adults with cirrhosis undergoing first-recorded paracentesis with initial PMN-C < 250 cells/mm 3 at 2 tertiary medical centers between 2015 and 2020. Patients with prior SBP were excluded. Outcomes were death and SBP development. Cox regression estimated hazard ratios (HRs) for risk of death and SBP development and Akaike information criterion to compare model fit.
Three hundred eighty-four adults (73% male, median age 58 years, 67% with alcohol-associated cirrhosis, median PMN-C 14 cells/mm 3 [interquartile range 5-34], and median PMN-% 10% [interquartile range 4-20]) were included in this study. Univariate risk of death increased 10% per 25-unit increase in PMN-C (95% confidence interval 1.01-1.21, P = 0.03) and 19% per 10-unit increase in PMN-% (95% confidence interval 1.06-1.33, P = 0.003) with PMN-% demonstrating better model fit in assessing mortality risk (Akaike information criterion: 1,044 vs 1,048, respectively). In models adjusted for age, chronic hepatitis C virus infection, and Model for End-Stage Liver Disease-Sodium, PMN-% was associated with risk of death (PMN-% 10%-29%, HR 1.17, P = 0.50; PMN-% ≥ 30% group, HR 1.94, P = 0.03; vs PMN-% < 10%) and SBP development (PMN-% 10%-29%, HR 1.68, P = 0.07; PMN-% ≥ 30%, HR 3.48, P < 0.001; vs PMN-% < 10%).
Our results suggest PMN-% at first paracentesis represents a better biomarker compared with PMN-C for assessing risk of death and future SBP development in patients with PMN-C < 250 cells/mm 3 .
腹水中性粒细胞绝对计数（PMN-C）≥250 个/毫米 3 是自发性细菌性腹膜炎（SBP）的诊断标志，与高发病率和死亡率相关。然而，PMN-％和 PMN-C 在没有 SBP 的情况下作为死亡率和未来 SBP 发生率的额外生物标志物的临床意义尚未确定。
本回顾性队列纳入了 2015 年至 2020 年在 2 家三级医疗中心接受首次记录的腹水穿刺术且初始 PMN-C＜250 个/毫米 3 的肝硬化成人患者。排除了有既往 SBP 病史的患者。结局为死亡和 SBP 发生。Cox 回归估计了死亡和 SBP 发生风险的风险比（HRs），并使用赤池信息量准则（Akaike information criterion）来比较模型拟合度。
本研究纳入了 384 名成人患者（73%为男性，中位年龄 58 岁，67%为酒精性肝硬化，PMN-C 中位数为 14 个/毫米 3 [四分位距 5-34]，PMN-％中位数为 10% [四分位距 4-20]）。单因素分析显示，PMN-C 每增加 25 个单位，死亡风险增加 10%（95%置信区间 1.01-1.21，P=0.03），PMN-％每增加 10 个单位，死亡风险增加 19%（95%置信区间 1.06-1.33，P=0.003），PMN-％在评估死亡率风险方面具有更好的模型拟合度（赤池信息量准则：分别为 1044 和 1048）。在调整年龄、慢性丙型肝炎病毒感染和终末期肝病模型钠后，PMN-％与死亡风险相关（PMN-％为 10%-29%组，HR 1.17，P=0.50；PMN-％≥30%组，HR 1.94，P=0.03；与 PMN-％＜10%相比）和 SBP 发生（PMN-％为 10%-29%组，HR 1.68，P=0.07；PMN-％≥30%组，HR 3.48，P＜0.001；与 PMN-％＜10%相比）。
我们的研究结果表明，PMN-C＜250 个/毫米 3 的患者首次腹水穿刺术时的 PMN-％比 PMN-C 更能作为评估死亡率和未来 SBP 发展风险的生物标志物。
