Abstract

Dr. Kamal A. Ata, *Khaled F. Alkhayat, Amr M. Zaghloul and Hala A. El-Sayed

ABSTRACT

Background: Spontaneous bacterial pleuritis or spontaneous bacterial empyema (SBEM) is the natural infection of a hepatic hydrothorax. SBEM is often under diagnosed although it`s associated with a bad outcome, mortality reaching 38%. Objectives: This study was designed to study the prevalence of SBEM in patients with liver cirrhosis and hepatic hydrothorax and to determine the possible risk factors contributing to the development of SBEM. Patients and Methods: The present study included patients with liver cirrhosis and hepatic hydrothorax admitted to the Chest, Tropical medicine & Gastroenterology departments, Sohag University Hospitals during the period between October 2017 to October 2018. Sonographic guided aspiration of the pleural and ascitic fluid was done, then the aspirate was subjected to chemical, bacteriological and cytological examination. Results: 105 patients (53.3% males) were included with a mean age of 59.7 years old, 13.3% of patients had SBEM, and 22.8% had SBP. 57.14% of cases with SBEM showed positive pleural fluid culture. E. Coli was the most common organism in culture positive patients (50%). Most patients with SBEM were presented with fever, chest pain, abdominal pain and septic shock. Presence of SBP, low serum albumin level, low pleural fluid protein level and advanced liver disease as expressed by high Child Pugh score and class C Child Pugh class together with prolonged INR were found to be independent risk factors for the development of SBEM. The mortality rate in patients with SBEM was 35.7%. Conclusion: This study confirmed that SBEM is a common complication in patients with liver cirrhosis and hepatic hydrothorax with increased risk of mortality. Many risk factors are associated with increased incidence of SBEM as presence of SBP, low serum albumin level, low pleural fluid protein level and advanced liver disease as expressed by high Child Pugh score and class C Child Pugh class together with prolonged INR.