Combination of PCT, sNFI and dCHC for the diagnosis of ascites infection in cirrhotic patients

Han Wang,Yan Li,Yuanli Mao,Ning Yang,Fangfang Zhang,Na Xie,Boan Li

doi:10.1186/s12879-018-3308-1

Abstract

BackgroundIt is difficult to diagnose ascites infection early in cirrhotic patients. The present study was to create and evaluate a new bioscore combined with PCT, sNFI and dCHC in the diagnosis of ascites infection in cirrhotic patients.MethodsTwo hundred and fifty-nine consecutive patients were enrolled; of which 51 patients were culture-positive spontaneous bacterial peritonitis (culture-positive SBP) and 58 patients were culture-negative SBP. The efficacy of procalcitonin(PCT), c-reactive protein (CRP), white blood cell (WBC), mean fluorescence intensity of mature neutrophils(sNFI) and difference in hemoglobin concentration between newly formed and mature red blood cells(dCHC) for diagnosing ascites infection was examined. These parameters were used to create a scoring system. The scoring system was analyzed by logistic regression analysis to determine which parameters were statistically different between ascites infection and non-ascites infection patients. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic ability of bioscore for ascites infection.ResultsIn ROC analysis, the area under the curves (AUC) for PCT was 0.852 (95% CI 0.803–0.921, P < 0.001), dCHC 0.837 (95% CI 0.773–0.923, P < 0.001), CRP 0.669 (95% CI 0.610–0.732, P = 0.0624), sNFI 0.838 (95% CI 0.777–0.903, P < 0.001), and WBC 0.624 (95% CI 0.500–0.722, P = 0.0881). Multivariate analysis revealed PCT, dCHC and sNFI to be statistically significant. The combination of these three parameters in the bioscore had an AUC of 0.937 (95% CI 0.901–0.994, P < 0.001). A bioscore of ≥3.40 was considered to be statistically significant in making a positive diagnosis of ascites infection. In different groups of ascites infection, bioscore also shown a high diagnostic value of AUC was 0.947(95% CI 0.882–0.988, P < 0.001) and 0.929 (95% CI 0.869–0.974, P < 0.001) for culture-positive SBP and culture-negative SBP group respectively.ConclusionThe composite markers of combining PCT, dCHC and sNFI could be a valuable diagnostic score to early diagnose ascites infection in patients with cirrhosis.

Highlights

It is difficult to diagnose ascites infection early in cirrhotic patients
To obtain the optimum sensitivity and specificity for detecting ascites infection, we developed the bioscore, the measured variable using an integer corresponding to its classification value (Additional file 1: Table S3)
Baseline population characteristics From among 357 consecutive ascites patients treated during the study period, 98 patients were excluded: 6 patients lacked clinical data were excluded; 41 patients were excluded because they had infections other than ascitic fluid infection; 28 because they had received antibiotics prior to hospital admission or enrollment in the study; and 23 because they had malignant ascites (Fig. 1)

Summary

Introduction

It is difficult to diagnose ascites infection early in cirrhotic patients. The present study was to create and evaluate a new bioscore combined with PCT, sNFI and dCHC in the diagnosis of ascites infection in cirrhotic patients. Ascites infections are considered intrications in cirrhotic patients with increasing mobility and mortality [1]. The initial diagnosis of ascites infection is primarily to enhance patient survival [2]. The diagnosis of ascites infections cases are based on proof of the independent number of polymorphonuclear cells(PMN) in the infected fluid ≥0.25 × 109cells/L, which is the most accurate sensitive value [4]. The time and availability of ascites are not constant at all-time [7], is essential to develop sensitive, accurate and rapid methods to diagnose ascitic fluid infection

Methods

Results

Conclusion