A188 LOW INCIDENCE OF SPONTANEOUS BACTERIAL PERITONITIS IN ASYMPTOMATIC OUTPATIENTS WITH CIRRHOSIS UNDERGOING PARACENTESIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Spontaneous bacterial peritonitis (SBP) is a common sequelae of ascites in patients with decompensated cirrhosis and is associated with significant morbidity and mortality. Current literature suggests SBP rates of 30% in hospitalized patients with decompensated cirrhosis. However, the incidence of SBP in asymptomatic outpatients undergoing large volume paracentesis is thought to be low, though there is a paucity of literature. Nevertheless, current AASLD guidelines recommend that all patients undergoing routine paracentesis have ascitic fluid analysis. The primary aim of our study was to perform a systematic review and meta-analysis to determine the incidence of SBP in asymptomatic patients undergoing routine large volume outpatient paracentesis. A systematic search of Medline and EMBASE was performed (to September 2017) along with a manual search of reference lists of retrieved articles. Two authors (OA, DR) independently reviewed articles retrieved. All studies looking at asymptomatic outpatients with decompensated cirrhosis were included. Data was extracted to determine the incidence of SBP (SBP; positive culture and polymorphonuclear cells (PMNs) greater than 250 PMNs/mm3), the incidence of culture-negative neutrocytic ascites (CNNA; PMN count greater than 250 PMNs/mm3), and the incidence of mononuclear bacterascites (MNB; positive ascitic culture but no elevation in PMNs). Pooled analysis was performed on studies when possible. A total of 309 articles were retrieved with 12 studies being included in the review. 7 were peer-reviewed publications while 5 were in abstract form. A total of 1307 patients were included and a total of 3684 paracentesis were performed. 9 studies provided information on SBP, CNNA or MNB while 3 studies did not specifically differentiate in their diagnostic parameters for SBP. The total incidence of any suspected infection (SBP, CNNA or MNB) was 3% (116/3684) of paracentesis. However, the incidence of definite SBP only was 0.5% (9/1728), while the incidence of SBP or CNNA was evident in 1% (24/1728) of paracentesis. The post-diagnosis management was variable between studies (either no treatment, outpatient antibiotics, or hospitalization). There is a low incidence of SBP and CNNA in asymptomatic outpatients with cirrhosis that require LVP. The utility of analyzing routine analysis of all samples in this population is debatable and likely not beneficial. Further studies are required to determine the cost-effectiveness of routine analysis and to determine whether certain subgroups are at higher risk of SBP. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.024 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".