The role of serum procalcitonin and C-reactive protein levels in predicting spontaneous bacterial peritonitis in patients with advanced liver cirrhosis.

Hongli Wu,Chao Meng,Lin Chen,Yuefeng Sun,Wei Hou

doi:10.12669/pjms.326.10995

Abstract

Objective:To determine the role of serum procalcitonin (PCT) and C-reactive protein (CRP) in predicting spontaneous bacterial peritonitis (SBP) in patients with advanced liver cirrhosis.Methods:A total of 88 patients with advanced liver cirrhosis were enrolled for this study, which included 40 cases with SBP and 48 cases with CNNA. Bacterial cultures, ascitic fluid (AF) leukocyte, C-reactive protein (CRP) and serum PCT measurements were carried out prior to the use of antibiotics. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels.Results:Serum PCT levels in advanced liver cirrhotic patients with SBP were significantly higher than those with CNNA. We used PCT 0.78 ng/mL as optimal cutoff value to diagnose SBP, for which the sensitivity and specificity was 77.5% and 60.4%. The area under the curve (AUC) was 0.706 (95% confidence interval: 0.576-0.798). The PCT level was significantly correlated with the AF WBC count (rs=0.404, P<0.01). However, there was no significant difference between SBP and CNNA patients in serum CRP levels.Conclusion:According to our findings, serum PCT levels seem to provide an early diagnostic accuracy in advanced liver cirrhotic patients with SBP.

Highlights

Ascitic fluid infection (AFI) is a common cause of morbidity in patients with advanced liver cirrhosis
All subjects met the following criteria: (1) liver cirrhosis with ascites and/or other complications were confirmed by medical history; (2) The ascitic fluid cultures, serum PCT and C-reactive protein (CRP) measurements, ascitic fluid WBC count were performed before the use of antibiotics at admission; (3) All enrolled patients have no infection in other organs or sites; (4) The patients did not exhibit liver failure, liver cancer or fungal infection
Patients with advanced Liver cirrhosis are very susceptible to bacterial infections because of acquired immune defects and bacterial translocation, which increases ascitic fluid infection

Summary

INTRODUCTION

Ascitic fluid infection (AFI) is a common cause of morbidity in patients with advanced liver cirrhosis. Over the last few years, the acute phase reactant proteins, such as C-reactive protein (CRP) and procalcitonin (PCT) have been investigated as tools for early diagnosis of SBP in various clinical conditions.[5,7] It is well known that CRP and PCT increased rapidly in response to bacterial infection They are sensitive diagnostic marker that can be used to predict diagnosis, monitor bacterial infections and guide the clinical use of antibiotics.[8,9] In this context, the purpose of the study was to evaluate the performance of CRP and PCT for the early diagnosis of SBP in patients with advanced liver cirrhosis

METHODS

RESULT

Findings

DISCUSSION