Abstract
BackgroundThe gold standard for the diagnosis of spontaneous bacterial peritonitis (SBP) is a polymorphonuclear leukocyte (PMNL) count of 250/mm3or more. Accurate and early diagnosis of SBP is important to decrease the mortality and complications in patients with cirrhosis.AimsThe aim of this study was to evaluate the accuracy of ascitic fluid calprotectin as a diagnostic marker for the detection of SBP.Patients and methodsSeventy Egyptian patients with liver cirrhosis and ascites were enrolled; these patients were divided into two groups: 50 patients with SBP and 20 patients with no SBP on the basis of an elevated ascitic PMNL count of 250 cells/mm3 or more. Ascitic samples were examined for PMNL count, culture, chemistry, and calprotectin concentrations in all patients.ResultsCalprotectin levels in ascitic fluid were correlated significantly with PMNLs and significantly higher in patients with SBP than non-SBP (P<0.001), with the best cutoff value for the detection of SBP of 783 ng/ml with a sensitivity, a specificity, a positive predictive value and negative predictive value, and an accuracy of 90, 100, 100, 80, and 92.9%, respectively.ConclusionElevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of SBP and considered a surrogate marker for PMNL.
Highlights
Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites
We found that the best cutoff value of Ascitic fluid (AF) Calprotectin as a diagnostic marker for spontaneous bacterial peritonitis (SBP) was 783 ng/ml with a sensitivity, a specificity, a positive predictive value (PPV), an negative predictive value (NPV), and an accuracy of 90, 100, 100, 80, and 92.9%, respectively
Calprotectin in AF was significantly higher in the SBP group than the non-SBP group and correlates well with the gold standard for diagnosing SBP, which is polymorphonuclear leukocyte (PMNL) of 250 cells/mm3 or more
Summary
Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites. SBP is estimated to affect 10–30% of cirrhotic patients hospitalized with ascites, with a mortality rate approaching 30% [1]. Ascitic fluid (AF) calprotectin reliably predicts ascitic polymorphonuclear leukocyte (PMNL), which may provide a useful marker for the diagnosis of SBP [3]. This work was planned with the aim of evaluating AF calprotectin as an accurate diagnostic marker for SBP. The gold standard for the diagnosis of spontaneous bacterial peritonitis (SBP) is a polymorphonuclear leukocyte (PMNL) count of 250/mm3or more. Accurate and early diagnosis of SBP is important to decrease the mortality and complications in patients with cirrhosis. Aims The aim of this study was to evaluate the accuracy of ascitic fluid calprotectin as a diagnostic marker for the detection of SBP. Ascitic samples were examined for PMNL count, culture, chemistry, and calprotectin concentrations in all patients
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