Correlation of poor oral hygiene and Ascitic fluid infection in patients with decompensated cirrhosis

Abstract

Background and Aims: Ascitic fluid infection [AFI] is one of the important complications of cirrhosis which has a poor prognosis. Bacterial translocation from gastrointestinal tract (GIT) is considered to be the most important mechanism that leads to development of AFI. Cirrhotic patients have bacterial overgrowth in the GIT and oral bacteria could be a source of infection. This study was conducted to assess correlation between AFI in patients with decompensated cirrhosis having poor oral hygiene.

Methods: A diagnostic paracentesis was performed under strict aseptic precautions. Ascitic fluid analysis was done within one hour of collection. Ascitic fluid was sent for microscopy, biochemistry and for culture sensitivity. Oral hygiene was examined for all patients by using the mouth mirror and shepherds hook to look calculate the simplified oral hygiene index (OHI-S)

 Results: Two hundred patients of decompensated cirrhosis were enrolled in the study with mean age of 50.9 + 9.85 years. There were 78 % males with a mean body mass index (BMI) of 18.9 + 1.9 kg/m². Alcohol was the major cause of cirrhosis (57%). Mean MELD and CTP scores were 18.6 +7.43 and 10.2 + 1.28 respectively. Mean OHI- S was 1.8+1.07. Poor oral hygiene was found in 61.54% patients with AFI compared to 17.57 % in patients without AFI (p<0.001). S – OHI so predicted presence of AFI with AUROC of 0.82.

Conclusion: We suggest screening for oral hygiene in all patients of decompensated cirrhosis as it may be a harbinger of ascitic fluid infection