Between May 2006 and October 2007 we prospectively recruited 150 patients with liver cirrhosis and ascites who were admitted for

hospitalization to the Department of Internal Medicine I, University Hospital Bonn, Germany. Criteria for inclusion were liver cirrhosis and ascites detected by ultrasound. Cirrhosis was diagnosed by clinical, laboratory, and ultrasound findings, or histology if available (fibrosis stage 4). All patients were of Caucasian ethnicity. The severity of the underlying liver disease was assessed according to the Model of End-stage Liver Disease (MELD) and the Child-Pugh score. The recruitment of the patients was approved by the human research ethics committee of the Medical Faculty at the University learn more of Bonn, and all patients provided informed consent for inclusion

in the study. After informed consent, we obtained EDTA-anticoagulated blood and serum samples for standard hematological, biochemical and coagulation tests, and performed buy R788 the index paracentesis. Ascites was analyzed for the following parameters: total and differential cell counts, total protein and albumin concentrations, pH, glucose and cholesterol levels as well as lactic acid dehydrogenase activity according to standard operational procedures of the clinical chemical laboratory. Ascitic cytology for differential white blood and polymorphonuclear neutrophil (PMN) cell counts was performed on a stained smear made from the sediment click here of 10 mL centrifuged ascitic fluid.17 Following the criteria of the International Ascites Club,1 SBP was diagnosed when the ascites PMN cell count was >250/μL. During the current and subsequent hospital stays, we monitored the occurrence of SBP and causes of death. Following

the consensus criteria for the systemic inflammatory response syndrome (SIRS),18 SIRS was diagnosed retrospectively when at least two of the following criteria were present: temperature <36°C or >38°C, heart rate >90 bpm, and white blood cell (WBC) count <4,000/mm3 or >12,000/mm3; because patients were admitted on our general wards without monitoring respiratory rates or PaCO2, these SIRS criteria could not be considered. In addition, we recorded treatment with antibiotics at the time of admission to our unit. Furthermore, we analyzed the patients’ medical history in our hospital and identified previous SBP episodes as defined above.