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Poster lunch

1219 - A retrospective study on peritoneal fluid analysis profiles to predict bacterascites associated with malignant ascites (508P)

Date

18 Nov 2017

Session

Poster lunch

Presenters

Hae Moon

Citation

Annals of Oncology (2017) 28 (suppl_10): x155-x165. 10.1093/annonc/mdx676

Authors

H. Moon1, S.H. Sim2

Author affiliations

  • 1 Department Of Internal Medicine, National Cancer Center, 410-769 - Goyang/KR
  • 2 Center For Breast Cancer, National Cancer Center, 410-769 - Goyang/KR
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Abstract 1219

Background

Neutrocytic ascites, defined as a polymorphonuclear neutrophil count ≥250/mm3, is equivalent to spontaneous bacterial peritonitis in cirrhotics and a strong indicator of bacterascites. The same profile is occasionally reported following paracenteses to relieve abdominal distension caused by malignant ascites. This study aimed to find out laboratory parameters to predict bacterascites in malignant ascites.

Methods

It was a retrospective study by reviewing electronic medical records at Emergency Department of National Cancer Center, Korea from January 2014 to Feb 2017. We analyzed clinical and laboratory data of the patients whose ascites profiles fulfilled the traditional criteria of neutrocytic ascites, polymorphonuclear neutrophils >250/mm3 while excluding patients with history of hepatocellular carcinoma or liver cirrhosis.

Results

1467 paracenteses to relieve malignant ascites were screened. Of these, excluding 98 follow-up paracentesis, 112 cases (8.2%) showed PMN >250/mm3. 27 of these (24.1%) proved to have bacterascites. Receiver Operating Characteristic analysis indicated that 0.90 (95% C.I. 0.82-0.95) was the area under curve for polymorphonuclear neutrophils ratio while 0.86 (95% C.I. 0.78-0.92) was for the PMN count. The difference was 0.042, not statistically significant (p = 0.29). Moreover, Youden’s statistics identified the best cutoff points: 70% for the ratio and 1500/mm3 for the count. In addition, sensitivity for the cutoffs was 81.5% and 74.1%; specificity, 85.9% and 84.6%, respectively.

Conclusions

The ratio and count of PMN had such strong association with bacterascites of malignant ascites that clinicians may predict the culture results. Also, the cutoff values proposed may indicate the cases that need antimicrobial treatments. To do that, however, the natural history of the condition should be further researched.

Clinical trial identification

Legal entity responsible for the study

National Cancer Center, Korea

Funding

Research grants (No.1731600-1) from the National Cancer Center, Goyang, Korea.

Disclosure

All authors have declared no conflicts of interest.Table: 508P

Five variables’ diagnostic parameters estimated by ROC analysis to predict bacterascites

PMN RatioPMN countAscites proteinAscites WBCSAAG
Optimal cutoff70%1500/mm318.0 g/L3000/mm31.1
Sensitivity(%)(95%C.I)81.5 (61.9-93.7)74.1 (53.7-88.9)40.7 (22.4-61.2)59.3 (38.8-77.6)65.4 (44.3-82.8)
Specificity(%)(95%C.I)85.9 (76.2-92.7)84.6 (74.7-91.8)20.0 (11.7-30.8)70.5 (59.1-80.3)64.9 (52.9-75.6)
+Predictability(%)(95%C.I)66.7 (52.9-78.1)62.5 (48.6-74.6)15.5 (10.3-22.7)41.0 (30.4-52.5)39.5 (30.1-49.8)
−Predictability(%)(95%C.I)93.1 (85.8-96.7)90.4 (83.2-94.7)48.4 (35.1-61.9)83.3 (75.6-89.0)84.2 (75.4-90.3)
AUC(95%C.I)0.90 (0.82-0.95)0.86 (0.78-0.92)0.73 (0.63-0.81)0.70 (0.60-0.78)0.68 (0.58-0.77)

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