To the Editor: In their Rational Clinical Examination study examining the performance and complications of paracentesis in cirrhotic patients with ascites and portal hypertension, Dr Wong and colleagues1 presented a comprehensive review of the literature in the context of a patient scenario. They provided evidence for analyses of ascitic fluid and suggested in their bottom line that, among other tests, the analysis of ascites pH and the calculation of the blood-ascitic fluid pH gradient are appropriate for diagnosing spontaneous bacterial peritonitis (SBP). However, the measurement of ascites pH and arterial pH is not recommended in guidelines on management of patients with ascites due to cirrhosis.2 In their scenario, they analyzed arterial and ascitic fluid pH but apparently did not use this information. Instead, their final decision to start broad spectrum antibiotic treatment for presumed SBP was based on the polymorphonuclear leukocyte (PMN) count.
De Gottardi A. Polymorphonuclear Leukocyte Count in Spontaneous Bacterial Peritonitis. JAMA. 2008;300(3):282-283. doi:10.1001/jama.2008.28