Performance of Early Therapeutic Paracentesis in Spontaneous Bacterial Peritonitis and Its Effect on Clinical Outcomes

Background and Aims: Spontaneous bacterial peritonitis (SBP) is common in decompensated cirrhosis and often accompanied by large volume ascites. However, the safety of early therapeutic paracentesis is unknown and may lead to unnecessary delay in procedural performance. We aimed to assess whether paracentesis performance characteristics in the setting of SBP influenced renal or circulatory outcomes. Methods: A single-center, retrospective cohort study was performed involving adult patients diagnosed with SBP based on ascites fluid studies during index admission between 2010 and 2020. Patient and procedural characteristics were collected and analyzed with respect to paracentesis timing (early vs. delayed) and volume (diagnostic only vs. non-large volume therapeutic vs. large volume therapeutic). The primary outcome was a composite of the development of AKI and/or circulatory dysfunction. Secondary outcomes included 30-day mortality, 90-day mortality, and change in baseline renal function. Results: One-hundred forty-four patients met inclusion criteria during the study timeframe (Child-Pugh C 74%, mean MELD-Na 25). Sixty-six (46%) met ACLF criteria at the time of SBP diagnosis. One-hundred eight (75%) patients underwent a therapeutic paracentesis, of which approximately two-thirds were performed within 24 h of admission (early); 41% were large volume (≥ 5 L of ascites removed). There was no difference in rates of the primary outcome with respect to either paracentesis timing or volume. Short-term mortality and change in baseline renal function were independent of procedural characteristics. Conclusions: Therapeutic paracentesis does not appear to induce renal or circulatory dysfunction in patients with SBP.