الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is an infection of the ascitic fluid in the absence of intra-abdominal source of infection characterized by an absolute polymorphnuclear cell count (PMNC) greater than 250 cells/mm3. SBP is a common and serious complication in patients with ascites caused by decompensated liver cirrhosis, with an incidence of 10% to 30%. The mortality has decreased markedly over the last decades, but it is still high, varying from 21 to 38% for in-hospital mortality. In daily practice, the diagnosis of SBP and other infections might be challenged by the fact that typical signs and symptoms, like fever or leukocytosis, are frequently absent. Therefore, a high index of suspicion is usually necessary for early diagnosis and treatment, which is associated with better outcomes. The prevalence of SBP in hospitalized patients and the mortality rate was reported to be 10-30% and 30-50% respectively. A 2016 study reported the recurrence rate of SBP to be 70% per year. Patients with SBP might present with or without symptoms. Fever, abdominal pain, ileus, diarrhea, acute variceal bleeding, and development or worsening of encephalopathy or ascites might occur at presentation or during follow-up . Alternatively, suspicion of SBP might arise from abnormalities in the laboratory, such as acute kidney injury, leukocytosis, and hyperbilirubinemia among others. Diagnosis is based on paracentesis with a polymorphonuclear leukocyte count ≥250/mm3 in ascitic fluid, with or without positive ascitic culture, in the absence of other cause of peritonitis (Piano et al, 2018). Ascitic fluid cultures are positive in 35%–65% of SBP episodes, with isolation of a single microorganism. The aim from our study was to evaluate clinical, laboratory characteristics and therapeutic measures associated within 30-day hospital readmission in patients with spontaneous bacterial peritonitis. Results of this study showed that : • Clinical and biochemical changes associated with recurrent SBP as decrease Ascitic fluid leucocytes, increase WBCs, PLT count, serum bilirubin and serum Creatinine. • Correlation between recurrent SBP and increase age, decrease MELD and decrease serum albumin. Age >60, MELD score ≤15, low serum albumin <2.5 can be used as risk factors and predictors for SBP recurrence. Conclusion This study shows that serum albumin and MELD score in addition to age can be used as simple, low-cost, non-invasive measures for prediction of SBP recurrence which helps its early management to reduce SBP recurrence and its complications. Recommendations • This work represents a small sized sample of Egyptian population. Therefore, additional studies with larger number of patients would be useful to confirm the clinical, laboratory and therapeutic measures associated with SBP patients. • Research on clinical and laboratory changes associated with SBP is still in early stage, and it needs to be clarified whether there are significant changes associated with recurrent SBP and effect of antibiotics on SBP outcome. • New protocol for managing SBP is urgently needed, taking into account geographic, ethnic variations and bacterial resistance, as well as recurrence issues.