Mansoura simple scoring system for prediction of spontaneous bacterial peritonitis: lesson learnt. Issue 8 (August 2019)

• Record Type: Journal Article
• Authors: Abdel-Razik, Ahmed; Mousa, Nasser; Abdel-Aziz, Mahmoud; Elsherbiny, Walid; Zakaria, Sahar; Shabana, Walaa; Abed, Sally; Elhelaly, Rania; Elzehery, Rasha; Eldars, Waleed; El-bendary, Mahmoud
• Is Part Of: European journal of gastroenterology & hepatology. Volume 31:Issue 8(2019)
• Publication Date: 2019-08
• Subjects: ascites -- liver cirrhosis -- mean platelet volume -- neutrophil-to-lymphocyte ratio -- spontaneous bacterial peritonitis; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001364
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background and objective: Spontaneous bacterial peritonitis (SBP) is a common bacterial infection with life-threatening sequelae in cirrhotic ascites. The purpose of this retrospective cohort study was to recognize the predictors of SBP to build up a noninvasive system to exclude or establish an episode of SBP. Patients and methods: Of 1194 consecutive patients with cirrhotic ascites, only 966 patients were enrolled in this study. SBP was diagnosed once polymorphonuclear count was at least 250 cells/mm 3 and/or there was a positive ascitic fluid culture result. Biochemical and clinical parameters were evaluated as predictors of SBP. A scoring system was established in the training group of 682 and validated in a second group of 284 participants. Results: The incidence of SBP was 12.3 and 12% in the training and validation groups, respectively. Age of at least 55 years, mean platelet volume (MPV) of at least 8.5 fl, neutrophil-to-lymphocyte ratio (NLR) of at least 2.5, and C-reactive protein (CRP) of at least 40 mg/l were identified as independent predictors of SBP. A scoring system including these four variables (age, MPV, and NLR with 1 point each, whereas CRP with 2 points) achieves a specificity of 98.2% with a positive predictive value for the diagnosis of SBP of 88.1% (score≥4). At a threshold of 1 point, the negative predictive value is 97.5% with a sensitivity of 92.9%. SBP is not associated with a high Model for End-stage Liver Disease score ( P =0.135). Conclusion: The combination of age, MPV, NLR, and CRP in a simple scoring system, Mansoura simple scoring system, supports quick and accurate exclusion or diagnosis of SBP.