Abstract
BackgroundSpontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in cirrhotic patients. High mortality associated with the delay in diagnosis and treatment. There is a need for an accurate and a rapid method for SBP diagnosis.ObjectivesWe aimed to evaluate ascitic fluid calprotectin as a diagnostic marker for SBP.Patients and methodsForty four cirrhotic patients were divided into two groups, non-SBP group: 22 patients with cirrhotic ascites without evidence of SBP and SBP group: 22 patients with cirrhotic ascites and SBP diagnosed by positive ascitic fluid bacterial culture and an increase in polymorphonuclear leukocytes (PMNLs) count in ascites (≥250 cells/mm3). Ascitic fluid calprotectin levels were measured using enzyme-linked immunosorbent assay.ResultsThere was a significant increase of ascitic fluid calprotectin, total leukocytic count, PMNLs, lactate dehydrogenase, and total protein in SBP group when compared to non-SBP group. There were significant positive correlations between white blood cell, ascitic fluid total leukocytic count, PMNLs, total protein, and model for end-stage liver disease score values and ascitic fluid calprotectin among SBP group. Ascitic fluid calprotectin with cutoff value 620 ng/ml, showed a sensitivity of 90.91% and a specificity of 95.45%, in diagnosis of SBP with positive predictive value 95.2% and negative predictive value 91.3%.ConclusionAscitic fluid calprotectin may be valuable in rapid diagnosis of SBP.
Highlights
Spontaneous bacterial peritonitis (SBP) is a bacterial infection of previously sterile ascitic fluids, in absence of a gastrointestinal perforation and an intraabdominal inflammatory lesions like abscess, cholecystitis, or acute pancreatitis [1]
Patients and methods Forty four cirrhotic patients were divided into two groups, non-SBP group: 22 patients with cirrhotic ascites without evidence of SBP and SBP group: 22 patients with cirrhotic ascites and SBP diagnosed by positive ascitic fluid bacterial culture and an increase in polymorphonuclear leukocytes (PMNLs) count in ascites (≥250 cells/mm3)
There was a significant increase of ascitic fluid calprotectin, total leukocytic count, PMNLs, lactate dehydrogenase, and total protein in SBP group when compared to non-SBP group
Summary
Spontaneous bacterial peritonitis (SBP) is a bacterial infection of previously sterile ascitic fluids, in absence of a gastrointestinal perforation and an intraabdominal inflammatory lesions like abscess, cholecystitis, or acute pancreatitis [1]. Gut bacteria is the most common organisms that infect the ascitic fluid [2]. In patients with SBP, death rate ranges from 40 to 70%. The mortality may decrease with rapid management of SBP [4]. SBP on admission had mortality rates up to 15%, and patients who recovered from a first SBP episode had decreased survival in comparison to cirrhotic patients without history of SBP [5]. Spontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in cirrhotic patients. There is a need for an accurate and a rapid method for SBP diagnosis
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