How Do Polymorphonuclear Counts in Ascitic Fluid Correlate to Hospital Outcome

Polymorphonuclear neutrophils (PMNs) are critical mediators in the innate immune response, and their levels in ascitic fluid are pivotal for diagnosing spontaneous bacterial peritonitis (SBP), particularly in patients with liver cirrhosis. This retrospective study investigates the association between varying PMN counts in ascitic fluid and hospital outcomes, including mortality, 30-day readmission rates, and length of stay (LOS). We analyzed de-identified data from HCA Healthcare hospitals (July 2013-December 2023), focusing on patients aged 18 and older with a diagnosis of liver cirrhosis who underwent paracentesis. Patients were categorized based on PMN counts into three groupings to assess their clinical outcomes. Our findings suggest that lower PMN counts correlate with increased mortality, particularly in groups with counts ≤100 and ≤200 cells/mm³. Conversely, higher PMN counts (201-249 cells/mm³) were associated with reduced odds of mortality. While 30-day readmissions demonstrated complex associations, higher counts also linked to increased readmission risk in the highest subgroup. Interestingly, LOS showed no significant differences across PMN levels. This study underscores the nuanced role of PMN counts in prognostication and treatment decisions for cirrhotic patients. Given emerging literature questioning the strict PMN diagnostic threshold for SBP, our results advocate for reconsideration of current guidelines to optimize patient management and outcomes. Further investigation is warranted to delineate the implications of PMN levels in the context of antimicrobial therapy and broader clinical strategies in liver disease management.