الفهرس 
Liver CirrhosisOnly 14 pages are availabe for public view
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Abstract
Spontaneous bacterial peritonitis (SBP) is a severe complication among cirrhotic patients with ascites and is defined as an infection in the ascitic fluid without a clear source in the abdomen. It is the most common infection in hospitalized cirrhotic patients, with a 20–30% mortality rate and comprising about 10–30% of all bacterial infections.
The clinical presentation of SBP is variable; for example, fever or leukocytosis might be absent, and about a third of the patients might be asymptomatic. Therefore, a high index of suspicion is necessary for early diagnosis, which is established when the polymorphonuclear leukocyte (PMNL) count in ascitic fluid exceeds 250 cells/μl.
Delayed diagnosis of SBP is associated with high morbidity and mortality rates. The diagnosis of SBP requires an invasive procedure, and the differential cell count is commonly performed manually using light microscopy and counting chambers. This method is subjective and time-consuming, and PMNL lysis during transfer to the laboratory may lead to false-negative results. Therefore, it is essential to develop rapid, reliable, and noninvasive techniques for diagnosing SBP.
The blood neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive biomarker that reflects the balance of the immune and inflammatory systems and the response to systemic inflammation. NLR is an indicator of subclinical inflammation. Increased neutrophil and decreased lymphocyte numbers in the peripheral blood may indicate the early stages of a severe infection. Several studies have demonstrated the clinical utility of NLR as a marker for bacterial infection.
The fact that the symptomatology of people with SBP varies from the presence of typical indicators to their lack leads to diagnostic challenges. Consequently, prompt detection and suitable intervention can assist in reducing the incidence of unfavorable consequences.
The aim of that study was to determine the role of neutrophil-to-lymphocyte ratio (NLR) as a predictor of spontaneous bacterial peritonitis (SBP) in patients with hepatitis C.
This Prospective cohort study was conducted at Hepatology Unit of Ain Shams University Hospital in period of 6 months over 80 cases divided into 2 equal groups.
• Study group: 40 patients with cirrhotic hepatitis C patients with sterile ascites
• Control group: 40 patients with cirrhotic hepatitis C patients with ascites with SBP
The main results of the study revealed that:
96 patients were included in our C, 16 of them were excluded (11 didn’t meet our inclusion criteria and 2 declined to participate) so we were left with 80 cases included in the C.
There was no statistically significant difference between the studied cases as regard demographic data
There was statistically significant difference between the studied cases as regard abdominal pain
There was no statistically significant difference between studied cases as regard scores
There was statistically significant difference between the studied cases as regard in ascitic fluid
There was statistically significant difference between the studied cases as regard lymphocytes, neutrophil/lymphocyte ratio and MPV
There was statistically significant difference between the studied cases as regard total bilirubin and creatinine
There was statistically significant difference between lab investigations at different time.