Abstract
BackgroundIt is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in decompensated liver cirrhotic ascites patients (DCPs). The aim of the study was to measure serum procalcitonin (PCT) levels and peripheral blood leukocyte/platelet (WBC/PLT) ratios to obtain an early diagnostic indication of SBP in DCPs.MethodsOur cohort of 129 patients included 112 DCPs (94 of whom had infections) and 17 cases with compensated cirrhosis as controls. Bacterial cultures, ascitic fluid (AF) leukocyte and peripheral WBC/PLT counts, and serum PCT measurements at admission were carried out prior to the use of antibiotics. Receiver operating characteristic (ROC) curves were generated to test the accuracies and cut-off values for different inflammatory markers.ResultsAmong the 94 infected patients, 66 tested positive by bacterial culture, for which the positivity of blood, ascites and other secretions were 25.8%, 30.3% and 43.9%, respectively. Lung infection, SBP and unknown sites of infection accounted for 8.5%, 64.9% and 26.6% of the cases, respectively. Serum PCT levels (3.02 ± 3.30 ng/mL) in DCPs with infections were significantly higher than those in control patients (0.15 ± 0.08 ng/mL); p < 0.05. We used PCT ≥0.5 ng/mL as a cut-off value to diagnose infections, for which the sensitivity and specificity was 92.5% and 77.1%. The area under the curve (AUC) was 0.89 (95% confidence interval: 0.84–0.91). The sensitivity and specificity were 62.8% and 94.2% for the diagnosis of infections, and were 68.8% and 94.2% for the diagnosis of SBP in DCPs when PCT ≥2 ng/mL was used as a cut-off value. For the combined PCT and WBC/PLT measurements, the sensitivity was 76.8% and 83.6% for the diagnosis of infections or SBP in DCPs, respectively.ConclusionSerum PCT levels alone or in combination with WBC/PLT measurements seem to provide a satisfactory early diagnostic biomarker in DCPs with infections, especially for patients with SBP.
Highlights
It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in decompensated liver cirrhotic ascites patients (DCPs)
Many studies have shown that serum procalcitonin (PCT) is a sensitive biomarker that can be used to monitor bacterial infections, and measurements of PCT levels may guide the clinical use of antibiotics [10]
All subjects met the following criteria: (1) decompensated liver cirrhosis with ascites and/or other complications were confirmed by medical history, liver function assessments and B ultrasonography (LOGIQ9, General Electric, Fairfield, USA) or computerized tomography (CT; GE HISPEED DXI, General Electric) examinations were proven cirrhosis; (2) the compensated cirrhosis was histologically diagnosed or peripheral PLT was 12.5 kPa by FibroScan®502 (ECHOSENS, French); (3) the pathogen cultures, serum PCT measurements, blood and ascitic fluid (AF) biochemistry tests and peripheral WBC/PLT counts were conducted before the use of antibiotics at admission; and (4) the patients did not exhibit liver failure, liver cancer or fungal infection or show serious heart, lung, or brain insufficiency, or have a mental illness
Summary
It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in decompensated liver cirrhotic ascites patients (DCPs). The aim of the study was to measure serum procalcitonin (PCT) levels and peripheral blood leukocyte/platelet (WBC/PLT) ratios to obtain an early diagnostic indication of SBP in DCPs. One of the most common and serious complications in decompensated cirrhotic patients (DCPs) is bacterial infection [1,2,3]. Ascites culture has been negative in about 60% of patients with clinical manifestations suggestive of SBP and increased ascites neutrophil count [8,9]. This study aimed to determine the diagnostic value of serum PCT levels alone, or in combination with the peripheral blood leukocyte and platelet count
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