Abstract
Background and aim: spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis and ascites. The diagnosis of SBP is established when the ascetic fluid polymorphnulear leukocyte (PMN) count is ≥ 250 cells / mm3 with or without a positive ascetic fluid culture. The objective of this study to measure macrophage inflammatory protein one beta (MIP-1β), mean platelet volume (MPV) and platelet distribution width (PDW) to evaluate their usefulness in the diagnosis of SBP in cirrhotic patients Patients/methods: A present study included 41 patients with liver cirrhosis and ascites. They divided into group SBP (21 patients) and group without SBP (20 patients) MIP-1β, MPV, PDW c-reactive protein (CRP) and total white blood cell count values were measured. The MIP-1β was measured in both serum and ascetic fluid. Results: A significant increase MPV, PDW, CRP and white blood cell was observed in SBP group compared to non SBP (P= <0.001, P= 0<0.004, P= 0.001, P= 0.001 respectively). In addition MIP-1β was significantly increased in ascetic fluid in patients with SBP versus non SBP (P= <0.001). A cutoff value of MPV 8.3 fl had 85.7% sensitivity and 75% specificity (Area under curve = 0.876) for diagnosis of SBP. A cutoff value PDW 15.4 had 90.4% sensitivity and 55% specificity (area under curve 0.762). a cutoff value MIP-1β in ascetic fluid was 121.9pg/ml had 76.1% sensitivity and 100% specificity (area under curve 0.881) for detecting SBP. Conclusion: MIP-1β and platelet indices are useful marker in diagnosis of SBP in cirrhotic patients particularly MIP-1β. Combined measurement of MIP-1β in serum and ascetic fluid was 100% sensitivity and specificity in diagnosis in SBP.
Highlights
Bacterial infections are frequently observed in patients with cirrhosis, among which spontaneous bacterial peritonitis (SBP) is probably the most serious complication in advanced cirrhosis of the liver [1]
Demographic and laboratory parameters of the studied groups are presented in (Table 1) most of patients had hepatitis C virus (HCV) infection which represent 75% of control group (Non SBP) and 84% of SBP group followed by bilharzias (15% in SBP and 10% in SBP) mixed HCV and bilharzias’ (10% in non SBP and 6% in SBP group)
This may be because platelet distribution width (PDW) is a measure of the variation of platelet width which can be an indicator of platelet activation, and may be related to inflammatory processes during the development of SBP this finding was not supported by Suvak et al, [24] who reported no significant changes in PDW in cirrhotic patients with SBP than without infection
Summary
Bacterial infections are frequently observed in patients with cirrhosis, among which spontaneous bacterial peritonitis (SBP) is probably the most serious complication in advanced cirrhosis of the liver [1]. On the basis of the results obtained from absolute white cell count and culture of the ascitic fluid (AF), five variants of peritoneal fluid infection have been recognized [3] These are 1) SBP: absolute count of polymorph nuclear leukocytes (PMNs) in AF of at least 250/mm and a positive culture showing a single type of bacteria; 2) culture-negative neutrocytic ascites (CNNA): negative AF culture with a PMN count greater than 250/mm3; 3) monomicrobial non-neutrocytic bacterascites: culture positive AF for one type of bacteria and a PMN count lesser than 250/mm3; 4) secondary bacterial peritonitis: characterized by polymicrobial growth from AF with a PMN count of at least 250/mm and a surgically treatable source of infection; and 5) polymicrobial bacterascites: PMN count less than 250/mm3 [4]. The mortality rate in patients with untreated SBP remains high (480%), but has declined to 30% - 40% as a result of early diagnosis and effective therapy using broad-spectrum antibiotics [6]
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