Evaluation of Granulocyte Elastase Enzyme in Diagnosis of Spontaneous Bacterial Peritonitis

Abstract

Background and study aim: The most common infections in decompensated liver cirrhotic ascites patients are cases of spontaneous bacterial peritonitis (SBP), which account for 40%–70% of cases. SBP is a bacterial infection that occurs in absence of an evident intra-abdominal or surgically treatable source of infection. Patients and methods: This study was conducted on 80 patients with liver cirrhosis and ascites; 40 patients of them without SBP (group A) and 40 patients of them with SBP (group B) who were admitted to the Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital in the period between April 2014 and October 2014. Full history taking, clinical examination and laboratory investigation were done. Ascitic fluid analysis was done including detection of granulocyte elastase level. Results: Granulocyte elastase was markedly elevated in group B; mean ascitic fluid GE ELISA (4.1±2.8) comparing with group A (0.8±0.7) and it revealed a high statistically significant association between SBP and GE (P value <0.05). SBP was more common in child C. Fever, hypotension and abdominal pain were more common in SBP group. Conclusion: Granulocyte elastase is increased in cases of SBP, cutoff value of ascitic fluid (GE) for diagnosis of SBP at 0.88 ng/mL had 100% sensitivity, 75% specificity, 80% positive predictive value, 100% negative predictive value and 87.5% accuracy.