The serum-ascites vitamin D gradient: a diagnostic marker for spontaneous bacterial peritonitis in Egyptian cirrhotic patients

Abstract

Background The most prevalent infectious consequence of liver cirrhosis is spontaneous bacterial peritonitis (SBP). Ascitic fluid polymorph nuclear neutrophils (PMN) counts of more than 250 cells/µL are used as the gold standard for diagnosing SBP. Patients with decompensated cirrhosis also had significantly decreased serum 25-OH vitamin D levels compared with controls. Aim Our aim is to investigate the role of (serum ascites vitamin D gradient) as a diagnostic factor for diagnosis of SBP. Patients and method This cross-sectional study included 80 cirrhotic ascitic patients from Egypt who were treated at the hospitals affiliated with the Tropical Medicine and Infectious Diseases Department at Tanta University. Group 1: 40 ascitic patients with SBP. Group 2: 40 ascitic patients without SBP History taking, clinical examination, laboratory analysis, and imaging studies were applied to every patient. Results Child-Pugh score was significant in both groups as child C was significantly higher in group 1 than group 2. Total leucocyte count and differential neutrophil were significantly higher in group 1 than group 2 while child B was higher in group 2 than group 1. Differential lymphocyte was significantly lower in group 1 than group 2. SADG was significantly lower in group 1 than group 2. SADG ratio can significantly predict SBP (P = 0.036 and AUC = 0.632) at cut-off less than or equal to −25.8 with 37.50% sensitivity, 95.00% specificity, 88.2% positive predictive value (PPV), and 60.3% negative predictive value (NPV). Conclusion Patients with cirrhotic ascites had decreased SADG and higher SBP. In these cases, it might be used as a diagnostic and prognostic marker for SBP. Patients with decompensated cirrhosis, independent of SBP, have an increased prevalence of vitamin D insufficiency.