-
The Journal of the Association of... Jun 2022Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently... (Observational Study)
Observational Study
BACKGROUND
Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. This is a retrospective observational study that aims to determine bacterial etiology, susceptibility patterns of SAI, and its correlation with model for end-stage liver disease-sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) score.
MATERIALS AND METHODS
The present study was conducted on 274 consecutive cases admitted in Bombay Hospital and Medical Research Centre, Mumbai, India. Cases of cirrhosis (irrespective of etiology) with ascites between the ages of 18-85 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures and was sent for biochemical, culture, and cytological analysis.
RESULTS
Of the 274 patients studied, 34 (12.4%) patients were diagnosed to have SAI. Culture-negative neutrocytic ascites (CNNA) was present in 27 patients, spontaneous bacterial peritonitis (SBP) was present in six patients, and monomicrobial bacteriascites was seen in one patient. Mean age of patients enrolled was 56.05 ± 2.47 years. Eighty-two percent were males and 18% were females. Alcohol (45.45%) was the leading cause of cirrhosis followed by nonalcoholic steatohepatitis (NASH) related cirrhosis (26.47.7%) and hepatitis C virus (HCV) related cirrhosis (11.46%) and cryptogenic cirrhosis (8.82%). Average MELD-Na score was 25 and the CTP class C was most common. Klebsiella pneumoniae was the most commonly isolated organism followed by Escherichia coli. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score, and high MELD-Na score.
CONCLUSION
Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Early diagnosis and treatment will reduce the mortality rate in these patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; Ascites; Ascitic Fluid; Bacterial Infections; End Stage Liver Disease; Escherichia coli; Liver Cirrhosis; Peritonitis; Severity of Illness Index
PubMed: 35702843
DOI: 10.5005/japi-11001-0023 -
BMC Infectious Diseases Jun 2018Spontaneous bacterial peritonitis (SBP) and bacterascites (BA) represent frequent and serious complications in cirrhosis patients with ascites. However, few detailed...
BACKGROUND
Spontaneous bacterial peritonitis (SBP) and bacterascites (BA) represent frequent and serious complications in cirrhosis patients with ascites. However, few detailed data are available regarding the clinical and bacteriological feature of SBP or BA patients in China.
METHODS
We retrospectively analyzed bacteriological and clinical characteristics of patients with SBP and BA at Beijing 302 Hospital in China from January 2012 to December 2015.
RESULTS
A total of 600 patients with SBP (n = 408) or BA (n = 192) were enrolled. Patients with BA appeared to have a less severe clinical manifestation and lower mortality rate than patients with SBP. Gram-negative bacteria formed the majority of pathogens in SBP (73.9%) and BA (55.8%) cases. Higher ascitic fluid polymorphonuclear leucocytes (PMN) count and hepatocellular carcinoma were independent risk factors for BA episode progressing to SBP. The concentration of blood urea nitrogen (BUN) was independent risk factor for 30-day mortality of BA patients. For patients with SBP, the independent risk factors for 30-day mortality were age, Model for End-Stage Liver Disease (MELD) score, septic shock and hepatocellular carcinoma. Patients with third-generation cephalosporin or carbapenems resistant infection had a significantly lower survival probability. There were significant differences in clinical characteristics and outcome among the major bacteria. Multivariate analysis showed that patients infected with Klebsiella spp. had higher hazard ratio of 30-day mortality.
CONCLUSION
Our study reported the bacteriological and clinical characteristics of patients with SBP and BA. Higher ascitic fluid PMN count and hepatocellular carcinoma were found to be independent risk factors for BA episode progressed to SBP. Outcome of ascitic fluid infection in patients with cirrhosis was influenced by the type of bacteria and antimicrobial susceptibility.
Topics: Adult; Aged; Ascites; Ascitic Fluid; Asian People; Bacterial Infections; Carcinoma, Hepatocellular; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Peritonitis; Prognosis; Retrospective Studies; Risk Factors
PubMed: 29866104
DOI: 10.1186/s12879-018-3101-1 -
Human Reproduction (Oxford, England) Jan 2022Peritoneal fluid in ovulatory women is an ovarian exudate with higher estrogen and progesterone concentrations than in plasma. In the follicular phase, progesterone...
Peritoneal fluid in ovulatory women is an ovarian exudate with higher estrogen and progesterone concentrations than in plasma. In the follicular phase, progesterone concentrations are as high as plasma concentrations in the luteal phase. After ovulation, estrogen and progesterone concentrations in the peritoneal fluid are 5-10 times higher than in plasma, both in women with and without endometriosis. The histologically proliferative aspect without secretory changes of most superficial subtle lesions is not compatible with the progesterone concentrations in the peritoneal fluid. Therefore, we have to postulate a strong progesterone resistance in these lesions. The mechanism is unclear and might be a peritoneal fluid effect in women with predisposing defects in the endometrium, or isolated endometrial glands with progesterone resistance, or subtle lesions originating from the basal endometrium: the latter hypothesis is attractive since in basal endometrium progesterone does not induce secretory changes while progesterone withdrawal, not occurring in peritoneal fluid, is required to resume mitotic activity and proliferation. Hormone concentrations in the peritoneal fluid are an important factor in understanding the medical therapy of endometriosis. The effect of oestro-progestin therapy on superficial endometriosis lesions seems to be a consequence of the decreased estrogen concentrations rather than a direct progestin effect. In conclusion, the peritoneal fluid, being a secretion product of the ovarian follicule, deserves more attention in the pathophysiology and treatment of endometriosis.
Topics: Ascitic Fluid; Endometriosis; Endometrium; Estrogens; Female; Humans; Progesterone; Uterine Diseases
PubMed: 34849906
DOI: 10.1093/humrep/deab258 -
Anti-inflammatory & Anti-allergy Agents... 2020Diagnosis of Spontaneous Bacterial Peritonitis (SBP) depends mainly on ascetic fluid culture which may be negative in spite of the clinical suggestion of SBP and high...
BACKGROUND
Diagnosis of Spontaneous Bacterial Peritonitis (SBP) depends mainly on ascetic fluid culture which may be negative in spite of the clinical suggestion of SBP and high ascetic fluid neutrophilic count.
AIMS
This study aimed to evaluate the biological importance of amyloid A biomarker in both serum and ascetic fluid to diagnose SBP as early as possible and to compare it to other markers (C-reactive protein (CRP), and the neutrophil-to-lymphocyte ratio (NLR)).
METHODS
This study included 37 patients with hepatic ascites; twenty-two of them had SBP, and 15 patients did not have SBP. Serum and ascetic fluid amyloid A, ascetic fluid neutrophil, C-reactive protein, and neutrophil-to-lymphocyte ratio were measured in all subjects before the start of antimicrobial chemotherapy to the infected ones.
RESULTS
Both the serum and ascetic fluid amyloid and also, CRP were significantly higher in patients infected with ascetic fluid than others. The cut-off point of serum amyloid A for early detection of SBP was 9.25ug/ml with the high sensitivity and specificity. For ascetic amyloid A, the sensitivity and specificity were 90.09% and 60% at cut-off point 2.85ug/ml, respectively.
CONCLUSION
Amyloid A in serum and ascitic fluid can be considered as a good biomarker for early diagnosis of SBP.
Topics: Adult; Ascitic Fluid; Bacterial Infections; Biomarkers; Blood Proteins; C-Reactive Protein; Female; Humans; Liver; Male; Middle Aged; Peritonitis; Reference Standards; Sensitivity and Specificity; Serum Amyloid A Protein
PubMed: 30931865
DOI: 10.2174/1871523018666190401154447 -
Reproductive Biomedicine Online Jul 2021Are endometrial stem/progenitor cells shed into uterine menstrual blood (UMB) and the peritoneal cavity in women with and without endometriosis during menstruation?
RESEARCH QUESTION
Are endometrial stem/progenitor cells shed into uterine menstrual blood (UMB) and the peritoneal cavity in women with and without endometriosis during menstruation?
DESIGN
Women with (n = 32) and without endometriosis (n = 29) at laparoscopy (total 61), carried out during the menstrual (n = 41) and non-menstrual phase (n = 20) were recruited. The UMB, peritoneal fluid and peripheral blood were analysed by clonogenicity assay and flow cytometry to quantify the concentrations of endometrial clonogenic cells, SUSD2 mesenchymal stem cells (eMSC) and N-cadherin epithelial progenitor cells (eEPC).
RESULTS
Clonogenic endometrial cells, eMSC and eEPC were found in most UMB samples at similar concentrations in women with and without endometriosis. In contrast, 62.5% of women with endometriosis and 75.0% without (controls) had clonogenic cells in peritoneal fluid samples during menses. The eMSC were present in the peritoneal fluid of 76.9% of women with endometriosis and 44.4% without, and eEPC were found in the peritoneal fluid of 60.0% of women with and 25.0% without endometriosis during menses. Median clonogenic, eMSC and eEPC concentrations in peritoneal fluid were not significantly different between groups. More clonogenic cells persisted beyond the menstrual phase in the peritoneal fluid of women with endometriosis (menstrual 119/ml [0-1360/ml] versus non-menstrual 8.5/ml [0-387/ml]; P = 0.277) compared with controls (menstrual 76.5/ml [1-1378/ml] versus non-menstrual 0/ml [0-14/ml]; P = 0.0362). No clonogenic endometrial cells were found in peripheral blood.
CONCLUSIONS
Clonogenic endometrial cells, SUSD2 eMSC and N-cadherin eEPC are present in UMB and the peritoneal fluid of women with and without endometriosis. Further study of the function of these cells may shed light on the cellular origins of endometriosis.
Topics: Adult; Ascitic Fluid; Case-Control Studies; Decidua; Endometriosis; Female; Humans; Middle Aged; Stem Cells; Young Adult
PubMed: 34011465
DOI: 10.1016/j.rbmo.2021.04.008 -
Abdominal Radiology (New York) Jul 2018
Review
Topics: Ascitic Fluid; Humans; Intestines; Peritonitis, Tuberculous; Ultrasonography
PubMed: 29138891
DOI: 10.1007/s00261-017-1382-2 -
International Journal of Molecular... Oct 2021Most patients with ovarian cancer (OvCA) present peritoneal disseminated disease at the time of diagnosis. During peritoneal metastasis, cancer cells detach from the... (Review)
Review
Most patients with ovarian cancer (OvCA) present peritoneal disseminated disease at the time of diagnosis. During peritoneal metastasis, cancer cells detach from the primary tumor and disseminate through the intraperitoneal fluid. The peritoneal mesothelial cell (PMC) monolayer that lines the abdominal cavity is the first barrier encountered by OvCA cells. Subsequent progression of tumors through the peritoneum leads to the accumulation into the peritoneal stroma of a sizeable population of carcinoma-associated fibroblasts (CAFs), which is mainly originated from a mesothelial-to-mesenchymal transition (MMT) process. A common characteristic of OvCA patients is the intraperitoneal accumulation of ascitic fluid, which is composed of cytokines, chemokines, growth factors, miRNAs, and proteins contained in exosomes, as well as tumor and mesothelial suspended cells, among other components that vary in proportion between patients. Exosomes are small extracellular vesicles that have been shown to mediate peritoneal metastasis by educating a pre-metastatic niche, promoting the accumulation of CAFs via MMT, and inducing tumor growth and chemoresistance. This review summarizes and discusses the pivotal role of exosomes and MMT as mediators of OvCA peritoneal colonization and as emerging diagnostic and therapeutic targets.
Topics: Ascitic Fluid; Carcinoma, Ovarian Epithelial; Cell Line, Tumor; Cytokines; Epithelial-Mesenchymal Transition; Epithelium; Exosomes; Female; Humans; Intercellular Signaling Peptides and Proteins; Ovarian Neoplasms; Peritoneal Neoplasms; Peritoneum
PubMed: 34768926
DOI: 10.3390/ijms222111496 -
Frontiers in Bioscience (Landmark... Jan 2017Multiplex immunoassays range from small-scaled multiplex sandwich ELISAs in a planar or bead-based format to the more expanded antibody arrays employing direct sample... (Review)
Review
Multiplex immunoassays range from small-scaled multiplex sandwich ELISAs in a planar or bead-based format to the more expanded antibody arrays employing direct sample labeling. The plethora of data generated from these arrays could be of great interest to understand a complex disorder such as endometriosis. Multiplex immunoassay analysis may provide information on disease pathology and may lead to improved, timely diagnosis. Until now, the use of multiplex immunoassays has been limited in endometriosis. With the constant development of multiplex technologies, future studies should focus on implementing these techniques, and combining them with multivariate statistical analysis. In this review, we provide an overview of multiplex immunoassay methods used in endometriosis studies and the data sets acquired by these methodologies. These data and future studies might provide novel insights for biomarker discovery and investigation of the pathogenesis in endometriosis.
Topics: Ascitic Fluid; Blood Proteins; Endometriosis; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoassay; Multivariate Analysis; Proteins
PubMed: 27814626
DOI: 10.2741/4496 -
Scientific Reports Dec 2017Endometriosis is a debilitating condition that is categorized by the abnormal growth of endometrial tissue outside the uterus. Although the pathogenesis of this disease...
Endometriosis is a debilitating condition that is categorized by the abnormal growth of endometrial tissue outside the uterus. Although the pathogenesis of this disease remains unknown, it is well established that endometriosis patients exhibit immune dysfunction. Interleukin (IL)-33 is a danger signal that is a critical regulator of chronic inflammation. Although plasma and peritoneal fluid levels of IL-33 have been associated with deep infiltrating endometriosis, its contribution to the disease pathophysiology is unknown. We investigated the role of IL-33 in the pathology of endometriosis using patient samples, cell lines and a syngeneic mouse model. We found that endometriotic lesions produce significantly higher levels of IL-33 compared to the endometrium of healthy, fertile controls. In vitro stimulation of endometrial epithelial, endothelial and endometriotic epithelial cells with IL-33 led to the production of pro-inflammatory and angiogenic cytokines. In a syngeneic mouse model of endometriosis, IL-33 injections caused systemic inflammation, which manifested as an increase in plasma pro-inflammatory cytokines compared to control mice. Furthermore, endometriotic lesions from IL-33 treated mice were highly vascularized and exhibited increased proliferation. Collectively, we provide convincing evidence that IL-33 perpetuates inflammation, angiogenesis and lesion proliferation, which are critical events in the lesion survival and progression of endometriosis.
Topics: Animals; Ascitic Fluid; Cell Line; Cell Line, Tumor; Cytokines; Disease Models, Animal; Endometriosis; Endometrium; Female; Human Umbilical Vein Endothelial Cells; Humans; Inflammation; Interleukin-33; Interleukin-8; Mice; Mice, Inbred C57BL; Neovascularization, Pathologic
PubMed: 29263351
DOI: 10.1038/s41598-017-18224-x -
Asia-Pacific Journal of Clinical... Apr 2021Neutrocytic ascites, traditionally defined as a polymorphonuclear neutrophil count ≥250/mm , is infrequently reported during paracenteses to relieve malignant ascites...
Discrimination of ascitic fluid infection in malignant ascites by polymorphonuclear neutrophil ratio and count: Investigating the validity of count ≥250/mm as the one-size-fits-all criterion.
AIM
Neutrocytic ascites, traditionally defined as a polymorphonuclear neutrophil count ≥250/mm , is infrequently reported during paracenteses to relieve malignant ascites (MA). This study aims to explore new potential diagnostic criteria to discriminate ascitic fluid infection associated with MA and to examine the clinical and laboratory characteristics of neutrocytic ascites.
METHODS
The investigators retrospectively collected data on paracenteses to relieve MA at the Emergency Department of National Cancer Center, Korea, from January 2014 to February 2017. We analyzed the patients whose ascites fulfilled the traditional criteria for classification as neutrocytic ascites; polymorphonuclear neutrophils ≥250/mm with no history of either hepatocellular carcinoma or liver cirrhosis.
RESULTS
In total, 1467 patients underwent paracentesis to relieve MA. Excluding 98 follow-up paracenteses cases, 112 cases (8.2%) showed neutrocytic ascites. Of these 112 patients, 27 (24.1%) had positive culture results. Receiver-operating characteristic analysis indicated that the area under the curve (AUC) values were 0.90 (95% CI 0.82-0.95) and 0.86 (95% CI 0.78-0.92) for polymorphonuclear neutrophil ratio and count, respectively. The difference between the two AUCs was not statistically significant (P = .29). Moreover, the best cutoff points were 70% and 1500/mm for polymorphonuclear neutrophil ratio and count, respectively. In addition, extensive liver metastasis was a significant independent risk factor of MA associated with ascitic fluid infection.
CONCLUSIONS
Both polymorphonuclear neutrophil ratio and count had good discriminative abilities for culture results in MA. Polymorphonuclear neutrophil ratio was somewhat better despite lacking statistical significance compared to polymorphonuclear neutrophil count, with 70% as best cutoff.
Topics: Ascites; Ascitic Fluid; Female; Humans; Male; Middle Aged; Neutrophils; Retrospective Studies
PubMed: 32762145
DOI: 10.1111/ajco.13344