C-Reactive Protein and Resistin Detect Bacterial Infections in Liver Cirrhosis

Abstract

Introduction: Bacterial infection usually has poor outcome, but often full of diagnostic difficulties in cirrhotic patients. The role of clinical parameters such as systemic inflammatory response syndrome, leukocyte count, neutrophil count, and other markers remains unclear in liver cirrhosis patients. The aim of this study was to evaluate the usefulness of inflammatory markers and determined which markers were best for the diagnosis of infection in decompensated cirrhotic patients. Methods: This was a diagnostic study consisted of 80 cirrhotic patients admitted to Sanglah general hospital, Denpasar from August 2014 until July 2015. Prospective study was designed. Markers of infection consist of leukocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP) and resistin were measured. Accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results: Bacterial infections were noted in twenty patients (25%) and spontaneous bacterial peritonitis (SBP) was the most common infections occurred. NLR, CRP, and resistin were higher in bacterial infections group (p < 0.05). Multiple logistic regression analyses showed that CRP and resistin were predictive factor for occurrence of bacterial infections (p < 0.05). For the diagnosis of infection, baseline CRP - using a 11.65 mg/L cut-off value - and resistin - using a 13 ng/mL cut-off value - generated area under the receiver operating characteristic (ROC) curve of 0.796 and 0.787, respectively. The sensitivity, specificity, PPV, and NPV for CRP were 90%, 73%, 52.9%, and 95.7%, respectively. For resistin, the sensitivity, specificity, PPV, and NPV were 90%, 59%, 41.9%, and 94.6% respectively. Conclusion: In the present study, CRP level of 11.65 mg/L or resistin 13 ng/mL seem adequate in rule out infections. Pieri et al in 2014 found out that CRP is still reliable in prediction of bacterial infection in cirrhosis. Johansson et al stated that resistin increase in noncirrhotic patients with severe sepsis. Currently there are no data on resistin levels in cirrhotic patients with bacterial infections. This study showed that resistin may have role in bacterial infections. In conclusion, resistin and CRP showed good accuracy as screening tests in diagnosing bacterial infection in cirrhotic patients. In the future, these modalities may aid clinician in predicting which patient more likely to have infections.Figure: Distribution of the serum concentration of resistin (A), C-reactive protein (CRP) (B), and neutrophil-lymphocyte ratio (NLR) (C) in liver cirrhosis patients with or without infections.Figure: ROC curves of CRP and resistin for the diagnosis of infection at admission.Table: Table. Diagnostic accuracy of C-reactive protein and resistin in diagnosing infection in liver cirrhosis.