{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T09:49:17Z","timestamp":1762854557583,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Liver Institute PLLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Background: Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with decompensated cirrhosis and ascites. Diagnosis typically relies on an ascitic polymorphonuclear (A-PMN) cell count \u2265 250 cells\/high-power field (HPF). Methods: In this retrospective cohort study, 117 hospitalized patients with acute decompensation of chronic liver disease and a diagnostic paracentesis were evaluated. Clinical, laboratory, and imaging data were collected. Patients were stratified by A-PMN counts of \u226450, 51\u2013249, or \u2265250 cells\/HPF. Additional analysis was performed with patients stratified by ascitic white blood cell (WBC) count and albumin. Mortality risk was assessed at 28, 90, and 365 days. Results: Patients with A-PMN \u2264 50 cells\/HPF had the lowest 28-day mortality (8%). At 90 and 365 days, mortality risk was significantly higher for the A-PMN 51\u2013249 cells\/HPF group (90-day hazard ratio (HR) 3.55, p = 0.01; 365-day HR 2.43, p = 0.02), but not A-PMN \u2265 250 cells\/HPF group (90-day HR 2.95, p = 0.1; 365-day HR 2.95, p = 0.2). Ascitic WBC count did not significantly predict mortality, though higher counts were associated with extraperitoneal infections. Ascitic fluid albumin \u2264 1.0 g\/dL was independently associated with increased 365-day mortality (HR 3.53, p = 0.03). Conclusions: Binary SBP A-PMN thresholds may not adequately capture mortality risk in cirrhotic patients with ascites. Low ascitic albumin and intermediate A-PMN counts are associated with increased long-term mortality, suggesting the need for more nuanced diagnostic and prognostic criteria in SBP evaluation.<\/jats:p>","DOI":"10.3390\/pathophysiology32040062","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T08:57:41Z","timestamp":1762851461000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increased Mortality with Intermediate Ascitic Polymorphonuclear Cell Counts Amongst Patients with Cirrhosis: Time to Redefine the Care Approach"],"prefix":"10.3390","volume":"32","author":[{"given":"Shahid","family":"Habib","sequence":"first","affiliation":[{"name":"Liver Institute PLLC, Tucson, AZ 85716, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ball","sequence":"additional","affiliation":[{"name":"Transplant Department, HCA HealthONE Presbyterian St. Luke\u2019s, Denver, CO 80218, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Thomas","sequence":"additional","affiliation":[{"name":"Transplant Department, HCA HealthONE Presbyterian St. Luke\u2019s, Denver, CO 80218, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Traci","family":"Murakami","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, The Queen\u2019s Medical Center, West Oahu, HI 96706, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nehali","family":"Patel","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Division of Gastroenterology, Department of Medicine, Fontana, CA 92335, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandeep","family":"Yarlagadda","sequence":"additional","affiliation":[{"name":"Department of Medicine, Fountain Hills Medical Center, Fountain Hills, AZ 85268, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Patel","sequence":"additional","affiliation":[{"name":"Sonoran Sleep Center, Phoenix, AZ 85306, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, AdventHealth Porter Hospital, Denver, CO 80210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varun","family":"Takyar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Division of Medicine, Sutter Health, Antioch, CA 94513, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krunal","family":"Patel","sequence":"additional","affiliation":[{"name":"Borland Groover Specialists, Jacksonville, FL 32256, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Domingues","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Digestive Health Associates, Houston, TX 77024, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiu-Hsieh","family":"Hsu","sequence":"additional","affiliation":[{"name":"Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/j.jhep.2023.03.017","article-title":"Global burden of liver disease: 2023 update","volume":"79","author":"Devarbhavi","year":"2023","journal-title":"J. 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Hepatol."}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/32\/4\/62\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T09:47:05Z","timestamp":1762854425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/32\/4\/62"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["pathophysiology32040062"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology32040062","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,11]]}}}