Can You Rely on Your Clinical Impression to Exclude SBP?

• SBP is an important can't miss diagnosis, as the mortality rate even for treated patients is approximately 20%
• The incidence of SBP ranges from 2.5% (clinic setting) to 12% of all patients admitted with decompensated cirrhosis
• SBP is diagnosed by a neutrophil count > 250 or a positive ascitic fluid culture obtained via paracentesis

• Can our clinical impression exclude SBP without performing a paracentesis? Unfortunately, the answer is NO.
• Sensitivity of physician clinical impression is just about 75%, with a specificity of 34%
• Fever is uncommon in patients with SBP (sensitivity as low as 17%)
• Take Home Point: only a diagnostic paracentesis can reliably exclude SBP in patients admitted for decompensated cirrhosis

References

Chinnock B, Afarian H, Minnigan H, Butler J, Hendey GW. Ann Emerg Med 2008;52:268-73.