Baylor University Medical Center Proceedings July 2017 - 264

only yielded a diagnosis of SBP, suggesting that clinicians
were not successful in selecting patients at high risk of SBP.
Given the diﬃculty of predicting which patients have SBP
based on clinical features, and the low frequency of SBP (6%
in the current study) in all patients undergoing paracentesis, knowledge that SBP is exceedingly rare in patients with
minimal ascites is helpful.
The overall major adverse event rate in this study was 0.9%,
including two hemorrhagic complications. No risk factors were
identiﬁed, possibly due to the low number of cases. In both
cases, INR was <1.5 and platelet count >50. Similarly, bleeding
after paracentesis has not been reported to be related to operator
experience, elevated INR, or low platelet count (5). Ascitic ﬂuid
leakage and bowel perforation and infection are other major
adverse events associated with SBP (12), but did not occur
in any of the procedures in our series. As there are no known
variables predictive of major adverse events including bleeding,
it is important to deﬁne selection criteria and exclude patients
for diagnostic paracentesis. Though the reported mortality rate
associated with paracentesis is small, 0.16% to 0.39% (5, 12),
our ﬁndings suggest that certain patients could be excluded
based on the ascites pocket depth to minimize the exposure to
potential adverse events.
The primary limitations of this study are based on its singlecenter retrospective nature. Our sample size of 301 procedures
performed over the course of 6 months at our institution may
not be suﬃcient to identify risk factors of rare outcomes, e.g.,
adverse events. Given that only 2 adverse events were observed
in our study, the statistical power to identify risk factors was limited. A prospective study can validate our ﬁndings regarding the
suggested 5-cm threshold for selecting patients for diagnostic
paracentesis. It was interesting that total ascites drained correlated to depth of the largest pocket, but did not diﬀer between
patients with and without SBP. One study limitation is that the
presence of loculations was not documented in the chart, and
therefore it is possible that not all the ﬂuid was removed. Also,
we report a higher than expected rate of SBP among patients
with a cancer diagnosis. Future studies could assess whether

264

malignancy-related SBP is associated with undocumented liver
failure and portal hypertension (13, 14).
1.

3.
4.
5.

8.
9.
10.

11.

12.

13.
14.

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