Original article| Volume 10, ISSUE 4, P209-213, December 1999

Paracentesis vs. intraperitoneal reinfusion of concentrated ascites — effect on opsonic activity of ascites


      Background. Spontaneous bacterial peritonitis is a frequent and serious complication of cirrhotic ascites. An important defense mechanism of ascites against infection is opsonic activity, where the most important part is played by specific antibodies and C3 and C4 components of complement. The authors wanted to find out whether reinfusion of concentrated ascites or paracentesis can influence this activity. Methods. Twenty-six patients with cirrhosis of the liver and refractory ascites not corresponding to salt restriction and diuretics were divided into two groups. In 14 patients, a total of 25 therapeutic paracenteses were made; in 12 patients, a total of 19 reinfusions of concentrated ascites were performed intraperitoneally. In all patients, levels of IgG, IgA, IgM, C3 and C4 components of complement were assessed in ascites before and 24 h after the intervention. Results. After paracentesis no change of the investigated parameters was found. Reinfusion of concentrated ascites, on the other hand, led to a significant rise of IgG, IgA, IgM, C3 and C4 at the 0.5% level of significance. Conclusion. Treatment of refractory ascites by ultrafiltration and reinfusion intraperitoneally seems to increase opsonic activity of ascites and could be useful in the prevention of the development of spontaneous bacterial peritonitis.


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        • Conn HO
        • Fessel JM
        Spontaneous peritonitis in Laennec's cirrhosis caused by enteric organism: a relative common but rarely recognized syndrome.
        Ann Intern Med. 1964; 60: 568-580
        • Hoefs JC
        • Canawati HN
        • Sapico FL
        • Hopkins R
        • Weiner J
        • Montgomerie JZ
        Spontaneous bacterial peritonitis.
        Hepatology. 1982; 2: 399-407
        • Wilcox CM
        • Dismukes WE
        Spontaneous bacterial peritonitis: a review of patogenesis, diagnosis and treatment.
        Medicine. 1987; 66: 447-456
        • Inadomi J
        • Sonnenberg A
        Cost-analysis of prophylactic antibiotics in spontaneous bacterial peritonitis.
        Gastroenterology. 1997; 113: 1289-1294
        • Kaymakoglu SE
        • Eraksoy H
        • Okten A
        • et al.
        Spontaneous ascitic infection in different cirrhotic groups: prevalence, risk factors and the efficacy of cefotaxime therapy.
        Eur J Gastroenterol Hepatol. 1997; 9: 71-76
        • Pinzello G
        • Simonetti RG
        • Craxi A
        • Di Piaza S
        • Spano C
        • Pagliaro L
        Spontaneous bacterial peritonitis: a prospective investigation in predominantly nonalcoholic cirrhotic paatients.
        Hepatology. 1983; 3: 545-549
        • Titó L
        • Rimola A
        • Gines P
        • Llach J
        • Arroyo V
        • Rodes J
        Recurrence of spontaneous bacterial peritonitis in cirrhosis: frequency and predictive factors.
        Hepatology. 1988; 8: 27-31
        • Runyon BA
        • Squier S
        • Borzio M
        Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis.
        J Hepatol. 1994; 21: 792-796
        • Akalin G
        • Laleli Y
        • Telatar H
        Bacterial and opsonic activity of ascitic fluid from cirrhotics and non-cirrhotic patients.
        J Infect Dis. 1983; 147: 1011-1017
        • Ljubovič N
        • Bilič A
        • Kopjar B
        Diuretics vs. paracentesis followed by diuretics in cirrhosis: effect on ascites opsonic activity and immunoglobulin and complement concentration.
        Hepatology. 1994; 2: 346-353
        • Runyon BA
        • Hoefs JC
        Ascitic fluid chemical analysis before, during and after spontaneous bacterial peritonitis.
        Hepatology. 1985; 5: 257-259
        • Lata J
        • Matýšková M
        • Dı́tě P
        • Hertlová M
        • Julı́nková K
        • Prášek J
        Dialytic ultrafiltration and reinfusion of ascites intraperitoneally — danger of DIC?.
        Gut. 1994; 35 (Suppl. 4 (abstr)): A158
        • Hoefs JC
        • Runyon BA
        Spontaneous bacterial peritonitis.
        Disease-a-month. 1985; 31: 1-48
        • Runyon BA
        Low-protein-concentration ascitic fluid is predisposed to spontaneous bacterial peritonitis.
        Gastroenterology. 1986; 91: 1343-1346
        • Runyon BA
        Spontaneous bacterial peritonitis: an explosion of information.
        Hepatology. 1988; 8: 171-175
        • Bac DJF
        Spontaneous bacterial peritonitis: an indication for liver transplantation?.
        Scand J Gastroenterol (Suppl). 1996; 218: 38-42
        • Navasa M
        • Rimola A
        • Rodes J
        Bacterial infections in liver disease.
        Semin Liver Dis. 1997; 17: 323-333
        • Salmeron JM
        • Titó L
        • Rimola A
        • et al.
        Selective intestinal decontamination in the prevention of bacterial infection in patients with acute liver failure.
        J Hepatol. 1992; 14: 280-285
        • Hsieh WJ
        • Lin HC
        • Hwang SJ
        • et al.
        The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding.
        Am J Gastroenterol. 1998; 93: 962-966
        • Gines P
        • Rimola A
        • Planas R
        • Arroyo V
        Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of double-blind, placebo controlled trial.
        Hepatology. 1990; 12: 716-724
        • Soriano G
        • Guarner C
        • Teixido M
        • Tomas A
        Selective decontamination prevents spontaneous bacterial peritonitis.
        Gastroenterology. 1991; 100: 477-481
        • Campillo B
        • Dupeyron C
        • Richardet JP
        • Mangeney A
        • Leluan G
        Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacin.
        Clin Infect Dis. 1998; 26: 1066-1070
        • Runyon BA
        • Antillon MR
        • McHutchinson JG
        Diuresis increases ascitic fluid opsonic activity in patients who survive spontaneous bacterial peritonitis.
        J Hepatol. 1992; 14: 249-252
        • Runyon BA
        • McHutchison JG
        • Antilon MR
        • Akriviadis EA
        • Montano AA
        Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis.
        Gastroenterology. 1991; 100: 1737-1742
        • Potter BJ
        • Trueman AM
        • Jones EA
        Serum complement in chronic liver disease.
        Gut. 1973; 14: 451-456
        • Young L
        • Martin B
        • Mayer R
        Gram-negative rod bacteremia: microbiologic, immunologic and therapeutic consideration.
        Ann Int Med. 1977; 86: 456-471
        • Hoefs JC
        Spontaneous bacterial peritonitis: prevention and therapy.
        Hepatology. 1988; 8: 171-175
      1. Drutz DJ, Mills J, Immunity and infection. In: Sites DP, Stobo JD, Fudenberg HH, Wells JV, (Eds.). Basic and clinical immunology, 4th edn. Los Altos: Lange Medical Publications, 1982:209–232.

        • Fromkes JJ
        • Thomas FB
        • Mekhijan HS
        • Evans M
        Antimicrobial activity of human ascitic fluid.
        Gastroenterology. 1977; 73: 668-672
        • Horowitz M
        Phagocytosis of microorganism.
        Rev Infect Dis. 1982; 4: 104-123