Prevalence, Clinical Profile, and Outcome of Ascitic Fluid Infection in Children With Liver Disease.
J Pediatr Gastroenterol Nutr
; 64(2): 194-199, 2017 02.
Article
em En
| MEDLINE
| ID: mdl-27482766
ABSTRACT
OBJECTIVES:
Pediatric literature on spontaneous bacterial peritonitis (SBP) is limited. We evaluated the prevalence, subtypes, clinical profile, and effect on outcome of ascitic fluid infection (AFI) in children with liver disease.METHODS:
Children with liver disease-related ascites and subjected to paracentesis were classified as no-AFI and AFI (SBP, culture-negative neutrocytic ascites [CNNA], and monomicrobial non-neutrocytic bacterascites). Clinical and laboratory parameters, in-hospital mortality, and outcome in follow-up were noted.RESULTS:
Two hundred sixty-two children (163 boys; age 84 [1-240] months, chronic liver disease [CLD, nâ=â173], non-CLD [nâ=â89]) were enrolled. A total of 28.6% (nâ=â75) had SBP/CNNA, more common in CLD than non-CLD (55/173 [31.7%] vs 20/89 [22.4%]; Pâ=â0.1). A total of 50.6% SBP/CNNA cases were symptomatic for AFI. Gram-negative bacilli were isolated from 70% SBP cases. Twenty-five percent (18/72) CLD children with AFI had a poor hospital outcome, with INR, Child-Pugh score and gastrointestinal bleeding predicting outcome on multivariate analysis. Patients with CLD with SBP had higher in-hospital mortality (10/20 vs 5/35; Pâ=â0.01) than those with CNNA, but similar Child-Pugh score (12[7-15] vs 11[7-14]; Pâ=â0.1), recurrence of AFI (3/9 vs 6/24; Pâ=â0.6) and mortality in follow-up (22.2% vs 25%; Pâ=â0.1). Patients with CLD with SBP/CNNA had higher mortality over 1 year follow-up than no-AFI (24.2% [8/33] vs 12.2% [7/57]; Pâ=â0.1) but the difference was not significant.CONCLUSIONS:
A total of 28.6% children with liver disease-related ascites have SBP/CNNA; 50% are symptomatic. Patients with CLD with SBP/CNNA have a mortality of 24% over 1year follow-up. CLD with SBP is similar to CNNA except for higher in-hospital mortality.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Peritonite
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Ascite
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Líquido Ascítico
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Infecções por Bactérias Gram-Positivas
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Infecções por Bactérias Gram-Negativas
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Hepatopatias
Tipo de estudo:
Diagnostic_studies
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Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
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Adult
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article