Diagnosis of spontaneous bacterial peritonitis

Naglaa A El-Gendy,Rayyh A Saleh,Eman E Ahmad,Enas E Radwan,Naglaa A Tawfeek,Rehab A Mohammed

doi:10.4103/1110-7782.139525

Naglaa A El-Gendy, Rayyh A Saleh + Show 4 more

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https://doi.org/10.4103/1110-7782.139525

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Abstract

BackgroundSpontaneous infection of ascites is a severe complication of ascites and must be actively searched for. Many studies have been carried out on inflammatory markers and their levels in serum and ascitic fluid such as complement 3 (C3), complement 4 (C4), high-sensitive C-reactive protein (CRP), and procalcitonin, and have identified their role in the diagnosis of spontaneous bacterial peritonitis (SBP). The aim of our study was to measure and compare the serum and ascitic fluid levels of procalcitonin, high-sensitive CRP, C3, and C4 in patients with SBP and patients without SBP.Patients and methodsThis case–control study was carried out on 10 patients with cirrhotic ascites who were admitted with SBP and 20 patients with cirrhotic ascites with no existing evidence of SBP. Serum and ascitic fluid levels of C3, C4, high-sensitive CRP, and procalcitonin were determined using the enzyme-linked immunosorbent assay method.ResultsThe mean ± SD of the serum levels of C3, C4, high-sensitive CRP, and procalcitonin were 3.38 ± 2.12, 0.36 ± 0.25, 18.76 ± 6.37, and 136.79 ± 58.14, respectively, in group I, whereas their levels in group II were 2.04 ± 1.98, 0.36 ± 0.29, 16.80 ± 5.97, and 147.78 ± 58.65, respectively. The mean ± SD of their ascitic fluid levels were 0.21 ± 0.14, 1.84 ± 1.69, 1.96 ± 1.15, and 162.43 ± 82.51, whereas their levels in group II were 0.46 ± 1.01, 2.07 ± 1.93, 2.98 ± 5.90, and 180.51 ± 93.70, respectively. Surprisingly, all these results were statistically insignificant. However, an ascetic fluid polymorph nuclear leukocyte count higher than 200/mm3 has sensitivity, specificity, positive predictive value, and negative predictive value of 100% in the diagnosis of SBP.ConclusionAn ascitic polymorph nuclear leukocyte count higher than 200/ml was the accurate marker for the diagnosis of SBP.

Highlights

Ascites is the most common complication of liver cirrhosis and it develops as a consequence of portal hypertension and splanchnic vasodilatation [1].Spontaneous bacterial peritonitis (SBP) is one of the main infectious complications of cirrhosis and occurs in 8–30% of hospitalized patients with ascites [2]
The number of polymorph nuclear leukocytes (PMN) from the ascetic fluid obtained by paracentesis must exceed 250 cells/mm3 and only one germ must be isolated in the bacteriological cultures [5]
Adult patients who presented with cirrhotic ascites and were admitted with spontaneous bacterial peritonitis (SBP) diagnosed on the basis of clinical and laboratory diagnostic criteria for SBP: ascetic fluid PMNs greater than 250/mm3 and culture positive, ascetic fluid PMNs greater than 250/mm3 and culture negative, and ascitic fluid PMNs less than 250/mm3 and culture positive [12]

Summary

Introduction

Ascites is the most common complication of liver cirrhosis and it develops as a consequence of portal hypertension and splanchnic vasodilatation [1].Spontaneous bacterial peritonitis (SBP) is one of the main infectious complications of cirrhosis and occurs in 8–30% of hospitalized patients with ascites [2]. The 1-year probability of development of the first episode of SBP in end-stage liver disease patients with ascites is ∼10% [3] It is defined as an infection of the previously sterile ascitic fluid in the absence of a visceral perforation and in the absence of an intra-abdominal inflammatory focus such as abscess, acute pancreatitis, or cholecyctitis [4]. Many studies have been carried out on inflammatory markers and their levels in serum and ascitic fluid such as complement 3 (C3), complement 4 (C4), high-sensitive C-reactive protein (CRP), and procalcitonin, and have identified their role in the diagnosis of spontaneous bacterial peritonitis (SBP). The aim of our study was to measure and compare the serum and ascitic fluid levels of procalcitonin, high-sensitive CRP, C3, and C4 in patients with SBP and patients without SBP. An ascetic fluid polymorph nuclear leukocyte count higher than 200/mm has sensitivity, specificity, positive predictive value, and negative predictive value of 100% in the diagnosis of SBP

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