Haddadin Rakahn, Ghobrial Michael, Tabbah Tarek, Trad George, Ryan John, Gish Robert G, Shah Pinak
Department of Internal Medicine, HCA Healthcare, MountainView Hospital, 2880 N Tenaya Way, Las Vegas, NV 89128, USA.
HCA Healthcare Southern Hills Hospital, Department of Gastroenterology, Las Vegas, Nevada, USA.
J Community Hosp Intern Med Perspect. 2025 May 5;15(3):15-22. doi: 10.55729/2000-9666.1475. eCollection 2025.
Polymorphonuclear neutrophils (PMNs) are critical mediators in the innate immune response, and their levels in ascitic fluid are pivotal for diagnosing spontaneous bacterial peritonitis (SBP), particularly in patients with liver cirrhosis. This retrospective study investigates the association between varying PMN counts in ascitic fluid and hospital outcomes, including mortality, 30-day readmission rates, and length of stay (LOS). We analyzed de-identified data from HCA Healthcare hospitals (July 2013-December 2023), focusing on patients aged 18 and older with a diagnosis of liver cirrhosis who underwent paracentesis. Patients were categorized based on PMN counts into three groupings to assess their clinical outcomes. Our findings suggest that lower PMN counts correlate with increased mortality, particularly in groups with counts ≤100 and ≤200 cells/mm. Conversely, higher PMN counts (201-249 cells/mm) were associated with reduced odds of mortality. While 30-day readmissions demonstrated complex associations, higher counts also linked to increased readmission risk in the highest subgroup. Interestingly, LOS showed no significant differences across PMN levels. This study underscores the nuanced role of PMN counts in prognostication and treatment decisions for cirrhotic patients. Given emerging literature questioning the strict PMN diagnostic threshold for SBP, our results advocate for reconsideration of current guidelines to optimize patient management and outcomes. Further investigation is warranted to delineate the implications of PMN levels in the context of antimicrobial therapy and broader clinical strategies in liver disease management.
多形核中性粒细胞（PMNs）是先天性免疫反应中的关键介质，其在腹水中的水平对于诊断自发性细菌性腹膜炎（SBP）至关重要，尤其是在肝硬化患者中。这项回顾性研究调查了腹水中不同PMN计数与医院结局之间的关联，包括死亡率、30天再入院率和住院时间（LOS）。我们分析了HCA医疗保健医院（2013年7月至2023年12月）的去识别化数据，重点关注年龄在18岁及以上、诊断为肝硬化且接受腹腔穿刺术的患者。根据PMN计数将患者分为三组以评估其临床结局。我们的研究结果表明，较低的PMN计数与死亡率增加相关，尤其是在计数≤100和≤200个细胞/mm的组中。相反，较高的PMN计数（201 - 249个细胞/mm）与较低的死亡几率相关。虽然30天再入院显示出复杂的关联，但在最高亚组中，较高的计数也与再入院风险增加有关。有趣的是，住院时间在不同PMN水平之间没有显著差异。这项研究强调了PMN计数在肝硬化患者预后和治疗决策中的微妙作用。鉴于新出现的文献对SBP严格的PMN诊断阈值提出质疑，我们的结果主张重新考虑当前指南，以优化患者管理和结局。有必要进行进一步调查，以阐明PMN水平在抗菌治疗背景下以及肝病管理更广泛临床策略中的意义。
