Role of Calprotectin in Diagnosis of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites

Magdy Gad,Jehan Sabry,Abdelmonem Zawawy,Mohammad El-Shewi

doi:10.21608/aeji.2015.17843

Abstract

Background and study aim: The most common infection in decompensated hepatic patients with cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The aim of this work is to assess the value of calprotectin in ascitic fluid in diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis. Patients and Methods: In this cross section study, 80 cirrhotic patients were divided into (group A) 40 patients with non SBP and (group B) 40 patients with SBP, who attended the Hepatology Department Benha University Hospital. All the patients were evaluated by thorough history, clinical examination, laboratory investigations, ultrasonongraphy, diagnostic paracentesis with PMNLs count and Calprotectin which was measured in 1 mL ascetic fluid by ELIZA. Results: Calprotectin was high in SBP group with a highly statistical significant difference in SBP group compared to non SBP group so it can serve as a sensitive and specific diagnostic test for detection of SBP in cirrhotic patients with ascites. The sensitivity of the test was 90% with specificity of 62.5%, PPV of 70.5% and NPV of 86.5% with the cut-off level were 2.98 ng /ml and the area under the curve was 0.88. Conclusion: Ascitic calprotectin reliably predicts PMN count >250/μL, which may prove useful in the diagnosis of SBP, especially with a readily available bedside testing device.

Highlights

Liver cirrhosis is the clinical endstage of different entities of chronic liver disease when patients suffer from substantial mortality and morbidity, both of which are positively correlated with disease severity [1].Ascites is the most common complication in cirrhotic patients, and around 60% of patients with compensated cirrhosis develop ascites within 10 years of disease onset [2].Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites
SBP is estimated to affect 10%30% of cirrhotic patients hospitalized with ascites, and mortality in this group approaches 30% [3]
Many of these patients are asymptomatic, and it is recommended that all patients with ascites undergo paracentesis at the time of admission to confirm the SBP status [4]

Summary

Introduction

Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites. SBP is estimated to affect 10%30% of cirrhotic patients hospitalized with ascites, and mortality in this group approaches 30% [3]. Many of these patients are asymptomatic, and it is recommended that all patients with ascites undergo paracentesis at the time of admission to confirm the SBP status [4]. The most common infection in decompensated hepatic patients with cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The aim of this work is to assess the value of calprotectin in ascitic fluid in diagnosis of spontaneous bacterial peritonitis in patients with liver cirrhosis

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Conclusion