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Spontaneous bacterial peritonitis (SBP) is a severe complication of liver cirrhosis whose diagnosis is based on a polymorphonuclear leukocyte (PMN) value >250 mm3, yet this PMN value cannot identify all existing types. The aim of our study was to determine the clinical and biological factors that were associated with SBP and predict its occurrence, focusing on the neutrophil-to-lymphocyte ratio (NLR) as one of them. Our retrospective study included 216 patients with liver cirrhosis who were hospitalized between December 2019 and January 2010 at the Emergency County Clinical Hospital of 'St. Apostle Andrew' in Constanta, Romania. Demographic, clinical, and laboratory data were collected from patient observation sheets. The patients were divided into two groups: One group of patients with SBP and the other without SBP. The diagnosis of SBP was made when patients presented with PMN >250 mm3 and other causes of secondary bacterial peritonitis were excluded. The mean age of the patients was 61.25±10.67 years, and the alcoholic etiology of liver cirrhosis was most common (44%). Univariate logistic regression analysis showed that there was an association between biological parameters, such as serum white blood cells, total platelet count, total bilirubin, serum albumin, international normalized ratio, creatinine, erythrocyte sedimentation rate (ESR), serum sodium, alkaline reserve, and NLR, and clinical parameters, such us upper gastrointestinal bleeding and cardiac comorbidities in the occurrence of SBP. Multivariate analysis identified ESR and NLR as predictive factors in the occurrence of SBP. The area under the curve (AUC) was 0.916 [P<0.001, 95% confidence interval (CI) 0.870-0.949] for ESR and AUC was 0.963 (P<0.001, 95% CI 0.928-0.984) for NLR, respectively. In conclusion, the combination of these 2 biological parameters is useful in identifying or excluding SBP. [ABSTRACT FROM AUTHOR]

Spontaneous bacterial peritonitis (SBP) is a complication of liver cirrhosis with an increased in-hospital mortality rate. For this reason, the aim of the present study was to examine the main predictors of mortality in order to be able to identify high-risk patients in time and to guide the optimal treatment for prognosis improvement. We retrospectively collected demographic, clinical, laboratory and treatment data as well as data regarding length of stay and cost of hospitalization from 72 patients diagnosed with SBP between January 2010 and December 2019 in the Emergency Clinical Hospital St. Apostle Andrew, Constanta, Romania. Patients were divided into two groups: Those who survived and those who died. Logistic regression was used to identify a possible association between these factors and the increased risk of mortality. Univariate analysis revealed that clinical factors (fever, chills, and hepatic encephalopathy), biological factors such as serum and ascites leukocyte value, polymorphonuclear percentage (PMN), erythrocyte sedimentation rate (ESR) value, previous SBP episodes, and the presence of complications such as acute kidney injury (AKI), sepsis, and systemic inflammatory response syndrome (SIRS) were significantly associated with in-hospital mortality in patients with SBP. Multivariate analysis revealed that SIRS (P=0.0010) and fever (P=0.0258) were significantly associated with in-hospital mortality in patients with SBP. Findings of the present study suggest that, SIRS and fever were independent predictive factors of mortality in cirrhotic patients with SBP. [ABSTRACT FROM AUTHOR]

Potassium, the main constituent of the intracellular buffer system, is an electrolyte that requires careful monitoring due to its indispensable role in the body's homeostasis, as well as due to its involvement in muscle contraction and nerve conduction. Decreased plasma concentrations cause symptoms that can progress from fatigue, pain and muscle cramps, respiratory failure and arrhythmias with revealing electrocardiographic changes. Thus, any known patient with pathology that can induce or associate hypokalemia (e.g., anorexia nervosa, Zollinger-Ellison syndrome, malabsorption syndrome, osmotic diuresis, chronic diuretic therapy, secondary hyperaldosteronism, diabetes, metabolic alcalosis etc) should be closely monitorized and requires serum potassium level to be known at any new sign / symptom appeared as an indicator of hypokalemia. Restoring the normal level can be achieved by diet (eating foods rich in potassium) or by administration of potassium chloride, potassium bicarbonate or potassium phosphate. To support the importance of monitoring serum potassium level, we present the case of a known patient with mixed hepatic cirrhosis (B + ethanol), without etiological treatment, which is hospitalized for haematemesis, melenic stools, sclero-tegumentary jaundice and altered general condition. Biological tests detected severe anemia, hypokalemia, metabolic alcalosis, cytolysis and cholestasis syndrome, and upper digestive endoscopy identifies the bleeding sources of the upper digestive haemorrhage. Under pathogenic and symptomatic treatment, the patient presented an unfavorable evolution with the maintenance of severe hypokalemia and the occurrence of electrocardiographic and cardiac rhythm changes. [ABSTRACT FROM AUTHOR]