A significant percentage of patients died <= 6 weeks after presentaton.
Risk factors for mortality:
(1) advanced age (age range for those who died was 60 +/- 16 years while those who survived had a mean age of 46 years)
(2) cirrhosis
(3) delay in initiating appropriate therapy
(3a) delay in diagnosis (waiting for culture results)
(3b) delay in diagnosis (not considering tuberculosis
(3c) delay in starting therapy once diagnosis made
(3d) misdiagnosis
(3e) inappropriate therapy
Reasons for misdiagnosis:
(1) predominance of neutrophils in peritoneal fluid (may be diagnosed as bacterial peritonitis)
(2) presence of cancer, renal failure or other serious underlying disease
Practices associated with reduced mortality:
(1) performance of laparoscopy with peritoneal biopsy (diagnostic in 85-95%)
(2) early and aggressive therapy with antituberculous drugs
Molecular techniques for diagnosis like PCR were not studied but would allow for faster diagnosis than conventional culture.
