Optimizing Outcomes in Patients with Ascites Complicating Cirrhosis—Maximizing the Hour of Power

Excerpt

Acutely hospitalized patients with decompensated cirrhosis complicated by ascites are at increased risk for spontaneous bacterial peritonitis (SBP), the most common infection in this population, that is asymptomatic in up to one-third of patients [1‐3]. Diagnostic paracentesis is thus recommended on admission as an AASLD quality metric in this population, a procedure that in theory is easy to accomplish due to minimal training requirements, low complication rate, and the lack of need for pre-procedure coagulation studies [2‐5]. Furthermore, early paracentesis (< 1 day after admission) decreases the risk of acute kidney injury (AKI), intensive care unit (ICU) transfer, length of stay, and inpatient mortality [5‐7]. Moreover, diagnostic paracentesis prior to administration of antibiotics can help identify causative microorganisms, guide tailored therapy, combat the rising prevalence of multidrug-resistant organisms (MDROs) by avoiding antibiotics in patients without SBP, and appropriately identify patients who need secondary SBP prophylaxis. Unfortunately, diagnostic paracentesis may be declining in frequency in this population, especially in hospitals run by the US Department of Veterans Affairs [3, 5]. …