Prevalence, Clinical Profile and Outcome of Ascitic Fluid Infection in Children With Liver Disease.

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: 262 children (163 boys; age-84[1-240] months, chronic liver disease [CLD, n-173], non-CLD [n-89]) were enrolled. 28.6% (n = 75) had SBP/CNNA, more common in CLD than non-CLD (55/173 [31.7%] vs. 20/89 [22.4%]; p = 0.1). 50.6% SBP/CNNA cases were symptomatic for AFI. Gram negative bacilli were isolated from 70% SBP cases. 25% (18/72) CLD children with AFI had a poor hospital outcome, with INR, Child-Pugh score and gastrointestinal bleeding predicting outcome on multivariate analysis. CLD patients with SBP had higher in-hospital mortality (10/20 vs. 5/35; p = 0.01) than those with CNNA, but similar Child-Pugh score (12[7-15] vs. 11[7-14]; p = 0.1), recurrence of AFI (3/9 vs. 6/24; p = 0.6) and mortality in follow-up (22.2% vs. 25%; p = 0.1). CLD patients with SBP/CNNA had higher mortality over one year follow-up than no-AFI (24.2% [8/33] vs. 12.2% [7/57]; p = 0.1) but the difference was not significant. Conclusions: 28.6% children with liver disease related ascites have SBP/CNNA; 50% are symptomatic. CLD patients with SBP/CNNA have an AFI recurrence of 27.2% and mortality of 24% over 1year follow-up. CLD with SBP is similar to CNNA except for higher in-hospital mortality. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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