Ascites fluid PMN counts below the SBP threshold predict 30-day mortality in a national hospitalized cirrhosis cohort

Background: Complications in patients with cirrhosis often result from bacterial and bacterial product translocation. This translocation can occur because of portal hypertension, alterations in the gut microbiome, and immune dysregulation. We aimed to re-evaluate admission ascites PMN/mm 3 count as a biomarker of 30-day mortality. Methods: We identified veterans with cirrhosis using validated ICD-9/10 codes who had a paracentesis ≤24 hours of their index hospitalization in the Veterans Affairs Corporate Data Warehouse from 2009 to 2024. In multivariable analysis, we determined the prognostic significance of ascites PMN/mm 3 <100, 100–249, and ≥250. Results: The 4111 veterans who met the inclusion criteria were mostly older (66 y) men (96.3%) with alcohol-associated liver disease (31.1%) who experienced 16.9% 30-day mortality. Most patients (~80%) had an ascites PMN/mm 3 count <100. A roughly linear relationship between 30-day mortality was seen until the threshold of 100 PMN/mm 3 was reached, when the relationship plateaued. The OR for 30-day mortality of a PMN/mm 3 count 100–249 was 1.93 (95% CI: [1.55–2.38], p <0.001) after adjusting for age, CCI, liver disease etiology, admission lactulose use, SBP prophylaxis, serum WBC count, MELD-Na, and serum albumin. The 30-day mortality risk was not statistically different from the higher threshold of ≥250 PMN/mm 3 ( p =0.53). Conclusions: Admission ascites PMN/mm 3 count ≥100, compared with <100, independently predicts a doubling in 30-day mortality in a national cohort of hospitalized patients with cirrhosis. Larger prospective studies are needed to examine the optimal ascites fluid PMN (polymorphonuclear neutrophil) thresholds that increase mortality risk.