Ascitic Fluid Of Cirrhotic Patients Research Articles

A study of Ascitic Fluid of Cirrhotic patients with Spontaneous Bacterial Peritonitis; common microorganisms and their antibiotic Senstivity

Background: Spontaneous bacterial peritonitis (SBP) is an acute infection of otherwise sterile ascitic fluid in patients with decompensated liver cirrhosis. Gram negative bacteria are considered the main causative microorganisms of SBP. However, widespread use of antibiotics in cirrhotic patients has changed the microbial spectrum and the sensitivity patterns. Aim: To determine the frequency of different microorganisms and their sensitivity patterns in ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis and to see the impact of age, gender and duration of SBP on these patterns. Study design and duration: It was a prospective observational study conducted at Fatima Memorial Hospital, Lahore from December 2015 to December 2016. Methods: A total of 200 patients with clinical suspicion of SBP were enrolled in the study. Ascitic fluid sample was obtained within 6 hours of hospitalization and was sent to hospital laboratory. Culture reports were reviewed to determine the frequency of different microorganism as well as their sensitivity patterns to different antibiotics. Results: Out of 200 patients, the culture was positive in 113(56.53%) patients. Escherichia coli was seen in 35 (31.2%) patients, Acinobacter Spp was present in 18 (15.3%), Streptococcus in 15 (13.4%), Enterococcus in 14 (12.1%), Staphylococcus aureus in 13 (11.4%), MRSA in 12 (10.8%), and K. Pneumonia in 6 (5.7%) patients. Ceftazidime was sensitive in 73 (64.9%) cases, Cefotaxime was sensitive in 55 (49%), Ceftriaxone was sensitive in 50 (43.9%), Ciprofloxacin was sensitive in 49 (43.3%), Amikacin was sensitive in 36 (31.8%) Conclusion: The most frequent organism in ascitic fluid of SBP patients was E Coli, and the most sensitive antibiotic was ceftazidime. Keywords: Microbial Spectrum, Sensitivity Pattern,Spontaneous Bacterial Peritonitis (SBP), Ascitic Fluid

SAT-009-Pharmacokinetics of ertapenem in plasma and ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis

SAT-009-Pharmacokinetics of ertapenem in plasma and ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis

Assessment of calprotectin in ascitic fluid as a marker for spontaneous bacterial peritonitis diagnosis in cirrhotic patients

BackgroundSpontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in cirrhotic patients. High mortality associated with the delay in diagnosis and treatment. There is a need for an accurate and a rapid method for SBP diagnosis.ObjectivesWe aimed to evaluate ascitic fluid calprotectin as a diagnostic marker for SBP.Patients and methodsForty four cirrhotic patients were divided into two groups, non-SBP group: 22 patients with cirrhotic ascites without evidence of SBP and SBP group: 22 patients with cirrhotic ascites and SBP diagnosed by positive ascitic fluid bacterial culture and an increase in polymorphonuclear leukocytes (PMNLs) count in ascites (≥250 cells/mm3). Ascitic fluid calprotectin levels were measured using enzyme-linked immunosorbent assay.ResultsThere was a significant increase of ascitic fluid calprotectin, total leukocytic count, PMNLs, lactate dehydrogenase, and total protein in SBP group when compared to non-SBP group. There were significant positive correlations between white blood cell, ascitic fluid total leukocytic count, PMNLs, total protein, and model for end-stage liver disease score values and ascitic fluid calprotectin among SBP group. Ascitic fluid calprotectin with cutoff value 620 ng/ml, showed a sensitivity of 90.91% and a specificity of 95.45%, in diagnosis of SBP with positive predictive value 95.2% and negative predictive value 91.3%.ConclusionAscitic fluid calprotectin may be valuable in rapid diagnosis of SBP.

Are third-generation cephalosporins still the empirical antibiotic treatment of community-acquired spontaneous bacterial peritonitis? A systematic review and meta-analysis.

Spontaneous bacterial peritonitis (SBP) is a common complication among cirrhotic patients. Guidelines recommend third-generation cephalosporins (3GCs) as empiric antibiotic therapy (EAT) of SBP. Recently, a broad-spectrum EAT was shown to be more effective than cephalosporins in the treatment of nosocomial spontaneous bacterial peritonitis (N-SBP); however, the prevalence of 3GCs-resistant bacteria is high in the nosocomial setting and broad-spectrum EAT cannot be used in all cases of SBP. The aim of this study was to evaluate the 3GCs resistance distribution between N-SBP and community-acquired spontaneous bacterial peritonitis (CA-SBP) to clarify whether 3GCs are still an effective therapeutic intervention for CA-SBP. We searched for studies that reported the aetiology of SBP and the resistance profile of both gram-positive and gram-negative bacteria in MEDLINE and Google Scholar databases (since 1 January 2000 to 30 April 2017). A meta-analysis was carried out to estimate the risk difference [relative risk (RR) and 95% confidence intervals (CIs)] for 3GCs resistance in N-SBP and CA-SBP. Heterogeneity was assessed using the I-test. A total of eight studies were included, including 1074 positive cultures of ascitic fluid in cirrhotic patients; 462 positive cultures were from N-SBP and, among these, 251 (54.3%) were 3GCs resistant. Six hundred and twelve positive cultures were from CA-SBP and, among these, 207 (33.8%) were 3GCs-resistant SBP. A pooled RR of 3GCs resistance in N-SBP compared with CA-SBP showed a significant difference (RR=1.67, 95% CI: 1.14-2.44; P=0.008). We carried out two subgroup analyses: the first according to the median year of study observation (before vs. since 2008) and the second according to the country of the study (China vs. others). The studies carried out before 2008 (327 SBP-positive culture) showed a significantly higher risk for 3GCs-resistant strains in N-SBP compared with CA-SBP (RR=2.36, 95% CI: 1.39-3.99; P=0.001), whereas this was not found in SBP acquired after 2008 (RR=1.24, 95% CI: 0.83-1.84; P=0.29). N-SBP occurring in China had no significantly higher risk for 3GCs-resistant strains compared with CA-SBP (RR=1.44, 95% CI: 0.87-2.37; P=0.16). Our findings suggest that although the pooled RR of 3GCs resistance in N-SBP compared with CA-SBP show that 3GCs are still an effective option for the treatment of CA-SBP, the subanalysis of studies that enroled patients in the last decade did not show a significant higher RR of 3GCs resistance in N-SBP compared with CA-SBP. Therefore, in centres where local patterns of antimicrobial susceptibility (with low rates of 3GCs resistance) are not available, 3GCs should not be used initially for CA-SBP treatment. Future studies are needed to confirm this trend of 3GCs resistance.

Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis. This study was performed to compare the microbiological characteristics of nosocomial and community-acquired episodes of bacterial peritonitis in China. Five hundred and seventy-five strains were isolated from the ascitic fluid of cirrhotic patients from the Beijing 302 Hospital from January 2014 to December 2014. The patients in the community-acquired SBP (n = 264) and the nosocomial SBP (n = 311) groups exhibited significant differences in clinical symptoms (P < 0.01). In both groups, most of the bacteria were Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococcus and Enterococcus. There were more frequent gram-positive cocci (G+ C) in the nosocomial group (n = 170). Compared with the community-acquired group, the proportion of Enterococcus was significantly increased in the nosocomial group (9.0% vs. 16.6%, P < 0.05). The resistance rate of the main pathogenic bacteria to the recommended first-line drug in the guideline was very high. Community-acquired and nosocomial SBP groups exhibited differences in clinical symptoms and antibiotic susceptibility tests. Optimal treatments should be provided for these patients. We recommend that cefoperazone/sulbactam or piperacillin/tazobactam should be used for the empirical treatment of SBP.

Blood Microbiome Quantity and the Hyperdynamic Circulation in Decompensated Cirrhotic Patients.

BackgroundRecently, a complex microbiome was comprehensibly characterized in the serum and ascitic fluid of cirrhotic patients. In the current study, we investigated for the first time the induction of inflammatory pathways and Nitric Oxide, as well as the systemic hemodynamics in conjunction with the blood microbiome in a Child-Pugh class B cirrhotic cohort.Methods and FindingsWe used the Intestinal Infections Microbial DNA qPCR Array to screen for 53 bacterial DNA from the gut in the blood. Assays were designed using the 16S rRNA gene as a target, and PCR amplification primers (based on the Human Microbiome Project) and hydrolysis-probe detection. Eighteen systemic hemodynamic parameters were measured non-invasively by impedance cardiography using the BioZ ICG monitor. The inflammatory response was assessed by measuring blood cytokines, Nitric Oxide RNA arrays, and Nitric Oxide. In the blood of this cirrhotic cohort, we detected 19 of 53 bacterial species tested. The number of bacterial species was markedly increased in the blood of cirrhotic patients compared to control individuals (0.2+/-0.4 vs 3.1+/-2.3; 95% CI: 1.3 to 4.9; P = 0.0030). The total bacterial DNA was also increased in the blood of cirrhotic subjects compared to control subjects (0.2+/- 1.1 vs 41.8+/-132.1; 95% CI: 6.0 to 77.2; P = 0.0022). In the cirrhotic cohort, the Cardiac Output increased by 37% and the Systemic Vascular Resistance decreased by 40% (P< 0.00001 for both compared to control subjects). Systemic Vascular Resistance was inversely correlated to blood bacterial DNA quantity (- 0.621; 95% CI -0.843 to -0.218; P = 0.0060), blood bacterial species number (- 0.593; 95% CI -0.83 to -0.175; P = 0.0095; logistic regression: Chi Square = 5.8877; P = 0.0152), and serum Nitric Oxide (- 0.705; 95% CI -0.881 to -0.355; P = 0.0011). Many members of the Nitric Oxide signaling pathway gene family were increased in cirrhotic subjects.ConclusionsOur study identified blood bacterial DNA in ~ 90% of the cirrhotic patients without clinical evidences of infection, and suggests that the quantity of bacterial DNA in blood may stimulate signaling pathways, including Nitric Oxide, that could decrease systemic vascular resistance and increase cardiac output.

Monocyte Chemotactic Protein-1 Gene Expression in Blood and Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Background and study aim: Cirrhotic patients with ascites show a higher susceptibility to bacterial infections, monocyte chemotactic protein-1 (MCP-1) secretion is up-regulated during chronic hepatitis and correlates with the severity of hepatic inflammation. The aim of this work is to determine the level of expression of MCP-1 gene in blood and ascitic fluid in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) to evaluate its role in pathogenesis of SBP and its role in diagnosis. Patients and Methods: This study included 15 healthy subjects served as control group in addition to 35 cirrhotic patients due to HCV infection with ascites; classified into two groups, cirrhosis without SBP (15 patients) and cirrhosis with SBP (20 patients). All groups were subjected to quantitative estimation of MCP-1 gene expression in blood by real time PCR. In SBP and non SBP groups the gene expression were assessed in ascitic fluid also at diagnosis and reassessed in SBP group after treatment. Results: Blood and ascitic fluid expression of MCP-1 gene were significant higher in SBP group than non SBP group and control group. SBP group showed a significant decrease in level of MCP-1 gene expression in blood and ascitic fluid after resolution of infection by appropriate treatment of SBP. Conclusion: MCP-1 gene expression in both blood and ascitic fluid may be related to pathophysiology and course of SBP and can be used as a marker for diagnosis.

Variant of Ascitic Fluid Bacterial Infections in Patients of Liver Cirrhosis.

Background and aimsBacterial infections of ascitic fluid of cirrhotic patients are related to high morbidity and mortality. The aim of the study was to determine the variants of ascitic fluid bacterial infection in patients with advanced cirrhosis (Child Pugh Class C).Materials and methodsWe analyzed 35 consecutive cirrhotic patients of Child Pugh Class C with ascites attending the outpatient department (OPD) of Hepatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2008 to December 2009. Clinical and laboratory parameters of these patients were recorded.ResultsAmong the total 35 patients, eight patients were symptomatic and 27 patients were asymptomatic. Out of eight symptomatic patients, two had ascitic fluid bacterial infection (25%), whereas six of 27 asymptomatic patients (22.2%) had ascitic fluid bacterial infection.ConclusionBacterial infection should always be considered in patients with ascites with liver cirrhosis irrespective of their symptoms.How to cite this articleSarker JA, Alam MS, Khan M, Mahtab MA, Ashraf MS, Khondaker FA. Variant of Ascitic Fluid Bacterial Infections in Patients of Liver Cirrhosis. Euroasian J Hepato-Gastro-enterol 2015;5(2):131-133.

Absent in melanoma 2 triggers a heightened inflammasome response in ascitic fluid macrophages of patients with cirrhosis

Inflammation is a common event in the pathogenesis of liver cirrhosis. The inflammasome pathway has acquired significant relevance in the pathogenesis of inflammation, but its role in the inflammatory response in patients with decompensated cirrhosis remains unexplored. We performed a prospective study in which 44 patients with decompensated cirrhosis and 12 healthy volunteers were included. We isolated macrophages from blood and ascitic fluid and assessed the expression and activation of the inflammasome, its response to priming by bacterial products, and its association with the degree of liver disease. Macrophages from sterile ascitic fluids showed constitutive activation of caspase-1 and a marked increase in the expression of IL-1β, IL-18, and absent in melanoma 2 (AIM2) when compared to blood macrophages. Pre-stimulation of blood-derived macrophages from cirrhotic patients with bacterial DNA increased the expression of AIM2 and induced a higher AIM2-mediated inflammasome response than priming with other bacterial products such as lipopolysaccharide. By contrast, activation of the AIM2 inflammasome did not require a priming signal in ascitic fluid-derived macrophages, demonstrating the preactivated state of the inflammasome in these cells. Last, higher IL-1β and IL-18 production by ascitic fluid macrophages correlated with a more advanced Child-Pugh score. The inflammasome is highly activated in the ascitic fluid of cirrhotic patients, which may explain the exacerbated inflammatory response observed in these patients under non-infected conditions. Clinically, activation of the inflammasome is associated with a higher degree of liver disease.

Alterations in cytokine measurements in ascitic fluid of cirrhotic patients with and without spontaneous bacterial peritonitis

Abstract Aim: To determine the pattern of cytokine synthesis in the ascitic fluid (AF) of cirrhotic patients, with or without spontaneous bacterial peritonitis (SBP). Patients and methods: We

Sa1033 Oral Nutrition With a High Content of BCAA Improves the Liver Function and Major Symptoms of Decompensated Cirrhotic Patients Unresponsive to BCAA Granules Only

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a frequent and severe bacterial infection in patients with decompensated cirrhosis and ascites. Most organisms causing SBP are from intestinal microbial flora with Enterobacteriaceae and Escherichia coli being reported the most common organisms. However, studies of small series in recent years reported increasing frequency of SBP caused by Gram -positive bacteria in SBP. AIM: To evaluate microbial characteristics of ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis. METHODS: Medical records of 236 patients who underwent diagnostic paracentesis from July 1 2006 to July 1 2011 at Hershey Medical Center were reviewed. Pertinent data were collected and analyzed using SAS 1.1 software. RESULTS: One hundred ninety eight patients, age between 18-80 years old who had cirrhosis and ascites were included. The majority of the patients with end stage liver disease had either alcoholic liver disease or viral hepatitis or both. 145 (73.2%) were males and 53 (26.8 %) were females. Mean age was 54.8 years. Total 650 cultures were performed. 153 out of 650 cultures (23.5%) met criteria of spontaneous bacterial peritonitis based on absolute neutrophil count in ascitc fluid >250 cells/mm3. Bacteria grew in 86 cultures. 21 of the 86 cultures grew 2 or more micro-organisms, possible secondary to contamination, were excluded from this analysis. One culture grew candida. Fifty out of 64 (78.1%) cultures grew Gram-positive bacteria and 14/64 (21.9%) cultures grew Gram-negative bacteria. Most common organism isolated was coagulase negative Staphylococcus and the most common Gram-negative organism isolated was Klebsiella. Positive culture result of either Gram-positive or Gram-negative bacteria did not differ in age, MELD score, frequency of paracentesis, etiology of liver disease, or previous history of SBP. CONCLUSION: Our study shows increased frequency of Grampositive bacteria in patients with SBP which is a change in the pattern of SBP compared to current guideline. Larger prospective studies are needed to confirm this finding. The implication of such change is likely to modify treatment strategies particularly when empiric therapy is contemplated.

Detection of ascitic fluid infections in patients with liver cirrhosis and ascites

Background and study aims Ascitic fluid infections (AFIs) are the frequent complications of advanced liver disease. Bacterial translocation is considered a key step in the pathogenesis of gut-derived bacterial infections; mainly spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Bacterial DNA (bactDNA) in ascitic fluid and serum has been suggested as a surrogate marker for bacterial translocation. We attempted at the isolation and identification of bacteria in ascitic fluid in cirrhotic patients and the assessment of polymerase chain reaction (PCR) in ascitic fluid and serum. Patients and methods Fifty cirrhotic patients having ascites with no signs of infection were included. Ascitic fluid cultures were obtained from patients. Ascitic fluid and serum were subjected to DNA extraction and PCR for the universal amplification of a region of the 16S ribosomal RNA (16S rRNA) gene to detect bactDNA. Results Bacteria were isolated from 9 (18%) of the ascitic fluid samples, and were mainly Gram-positive bacteria. BactDNA was detected simultaneously in the ascitic fluid and serum of 17 (34%) patients and in the ascitic fluid of only 2 patients. In a single patient with positive ascitic fluid culture no bactDNA was detected in ascitic fluid or serum. By considering AFIs as a positive ascitic fluid culture and/or the presence of bactDNA in the ascitic fluid and/or serum, ascitic fluid culture could detect 9 out of 20 patients with AFIs (45%), PCR of ascitic fluid could detect 19 out of 20 (95%) while PCR of serum could detect 17 out of 20 (85%). In 10 patients with culture negative non-neutrocytic ascites (CNNNA) bactDNA could be detected in serum and ascitic fluid. Conclusion AFI can be caused by Gram positive as well as Gram negative organisms. A substantial percentage of cases with CNNNA show bactDNA in serum and ascitic fluid. PCR of ascitic fluid should, therefore, be used in the diagnostic workup of suspected cases of ascitic fluid infections.

Peritoneal macrophage priming in cirrhosis is related to ERK phosphorylation and IL‐6 secretion

Bacterial infections are common complications arising in patients with cirrhosis and ascites. Translocation of bacterial DNA is a dynamic process that is associated with an increased inflammatory response and a poor prognosis in this setting. The aim of this study was to study whether peritoneal macrophages remain in a chronic primed status to allow a rapid response to subsequent events of bacterial translocation. Peritoneal monocyte-derived macrophages were isolated from 25 patients with cirrhosis and non-infected ascites and compared with donor's blood monocytes. Activation cell-surface markers were screened using flow-cytometry, and the phosphorylation state of ERK 1/2, p38 MAP Kinase, PKB/Akt and transcription factors c-Jun and p65 NFκB were evaluated using Western blot. Synthesis of tumour necrosis factor alpha, interleukin 6 (IL-6) and interleukin-10 (IL-10) at baseline and in response to bacterial stimuli was evaluated using ELISA. A high expression of CD54, CD86 and HLA-DR at baseline was displayed by peritoneal macrophages. Increased phosphorylated levels of ERK1/2, protein kinase B (PKB) and c-Jun, together with IL-6 production, were observed in peritoneal macrophages at baseline compared with donors' blood monocytes. A positive correlation was established between basal IL-6 levels and extracellular signal-regulated kinase (ERK) phosphorylation in peritoneal macrophages from patients with cirrhosis (r=0·9; P=0·005). Addition of lipopolysaccharide induced higher phosphorylation levels of all studied signalling intermediates than synthetic-oligodeoxydinucleotides, but similar end-stage p65 NFκB. A sustained immune response is present in ascitic fluid of cirrhotic patients, even in the temporal absence of bacterial antigens. This would facilitate a fast response, probably controlled by IL-6, against repeated bacterial-DNA translocation or in liver chronic inflammation.

Study on ascitic fluid protein level in cirrhotic patients with spontaneous bacterial peritonitis

Complement 3 is an important component of ascitic fluid total protein, which offers local defence against infection of the ascitic fluid. Hepatic synthesis of complement 3 as well as other proteins and their concentrations in ascitic fluid is significantly reduced in patients with advanced cirrhosis. The level of protein in ascitic fluid in cirrhotic patients with spontaneous bacterial peritonitis was compared with that in patients without spontaneous bacterial peritonitis. Ascitic fluid protein level in spontaneous bacterial peritonitis (n=15) was 1.1 +/- 0.3 g/dL whereas it was 1.5 +/- 0.5 g/dL in patients without spontaneous bacterial peritonitis (n=15). In conclusion, this study suggests that, ascitic fluid protein level is significantly (p = 0.008) reduced in cirrhotic patients who develop spontaneous bacterial peritonitis.

Study On Ascitic Fluid Complement3 Level In Cirrhotic Patients With Spontaneous Bacterial Peritonitis And Without Spontaneous Bacterial Peritonitis

Ascitic fluid Complement 3 (C3) concentration is the most important factor to offer local defense against infection of ascitic fluid. Hepatic synthesis of Complement 3 and its concentration in ascitic fluid is significantly reduced in patients with advanced cirrhosis. The aim of the study was to assess the level of Complement 3 in ascitic fluid in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and to identify the group of cirrhotic ascites at risk of developingA prospective case control study was carried out to compare the level of ascitic fluid Complement 3 concentration in patients with SBP (case-group) and without SBP (control-group). Ascitic fluid Complement 3 level was estimated in 15 patients with SBP (case) and another 15 patients without SBP (control).In the study, ascitic fluid Complement 3 concentration was 7.3+/-4.3 mg/dL in patients with SBP and 16.4+/-11.3 mg/dL in patients who did not develop SBP.Ascitic fluid Complement 3 level is significantly (P=0.009) reduced in cirrhotic patients who develop SBP.

Validation of automated blood cell counter for the determination of polymorphonuclear cell count in the ascitic fluid of cirrhotic patients with or without spontaneous bacterial peritonitis

Objective Polymorphonuclear (PMN) cell count in ascitic fluid is the most useful test for the diagnosis of spontaneous bacterial peritonitis (SBP). We evaluated the validity of an automated blood cell counter for the PMN determination in ascitic fluid by comparing it with the traditional hematologic method with a light microscope in a manual counting chamber. Methods A total of 130 ascitic fluid samples were collected from 74 consecutive cirrhotics. The agreement between the two techniques was assessed according to Bland and Altman's method. The sensitivity, specificity, and positive and negative predictive values of the automated blood cell counter were calculated by considering the diagnosis of SBP as a PMN count ≥ 250 cells/mm 3, determined by the manual method as the “gold standard.” Results The mean PMN counts assessed by the manual method and the automated blood cell counter were 124 ± 301 cells/mm 3 and 130 ± 339 cells/mm 3, respectively ( p = 0.89, ns). The mean ± SD of the difference between manual and automated measurements was 6 ± 61 cells/mm 3, whereas the limits of agreement were +127 cells/mm 3 (95% CI = +108 to +147) and −115 cells/mm 3 (95%CI = −96 to −135). SBP was diagnosed in 11 patients. All but one were correctly identified with the automated blood cell counter, with a sensitivity of 94% and a specificity of 100%; positive and negative predictive values were 100% and 99.1%, respectively. Conclusions The manual method and the automated blood cell counter have a good agreement in the PMN determination in ascitic fluid, and the automated blood cell counter is a reliable tool for rapid diagnosis of SBP.

Interleukin 6 concentration in ascitic fluid of cirrhotic patients: relationship with previous episodes of spontaneous bacterial peritonitis.

We aimed to determine whether inter-leukin (IL)-6 concentrations in plasma and ascitic fluid from cirrhotic patients with previous episodes of spontaneous bacterial peritonitis (SBP) differred from those with no previous episodes of SBP. Cirrhotic patients with ascites were divided into two groups: G1, without previous episodes of SBP (n = 6), and G2, with previous episodes of SBP (n = 6). Patients with chronic heart failure (n = 5) with ascites, without hepatic diseases, were included as controls (G3). IL-6 concentration was determined in ascitic fluid and plasma by enzyme-linked immunosorbent assay (ELISA). A group of healthy subjects (n = 8) was used as a control for the blood IL-6 assay. IL-6 concentration in ascitic fluid was significantly higher in G1 (P < 0.05) than in G2 or G3. No significant difference in plasma IL-6 concentrations was observed between the groups or between each group and the healthy subjects. A significant positive linear correlation (P < 0.002) was observed between IL-6 concentration and total protein in ascitic fluid. A low concentration of IL-6 in ascitic fluid could predispose cirrhotic patients to SBP.

Correlation of high levels of hyaluronan and cytokines (IL-1beta, IL-6, and TGF-beta) in ascitic fluid of cirrhotic patients.

Our objective was to investigate the relationship between endotoxin and hyaluronan synthesis and release in serum and ascitic fluid from cirrhotic patients. We studied hyaluronan, endotoxin, albumin, and creatinine levels in ascitic fluid and plasma and cytokine levels (IL-1beta, IL-6, TGF-beta) in ascitic fluid. TGF-beta, IL-6, and IL-1beta correlation analyses indicated a strong dependence of the production of these cytokines on endotoxin levels. Correlation analyses for TGF-beta and IL-6 indicated a strong dependence of the production of hyaluronan on cytokine levels and, to a lesser extent, on IL-1beta levels. Hyaluronan analysis indicated that a certain glycosaminoglycan level is required in ascites before its appearance in plasma. Our results disclosed elevated plasma hyaluronan concentrations. The simultaneous increased hyaluronan levels in ascitic fluid do not seem to be derived from the systemic circulation. In conclusion, the high hyaluronan-ascites/hyaluronan-plasma ratio suggests an intrinsic hyaluronan production from peritoneal cells induced by endotoxins.

AMP deaminase activity and urate levels in sera and ascitic fluid of cirrhotic patients as biochemical markers of tissue hypoxia

AMP deaminase activity and urate levels in sera and ascitic fluid of cirrhotic patients as biochemical markers of tissue hypoxia

Ascitic Fluid Interleukin-8 to Distinguish Spontaneous Bacterial Peritonitis and Sterile Ascites in Cirrhotic Patients

Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal complication of cirrhosis. The pathogenesis of spontaneous ascitic fluid infection appears to involve translocation of bacteria from the gut to the mesenteric lymph nodes, depressed reticuloendothelial phagocytic activity, and deficient ascitic fluid antibacterial activity. A high index of suspicion of this infection and a low threshold for performing an abdominal paracentesis are required to detect infection early, when survival is most likely (1). Interleukin-8 (IL-8) is a cytokine produced by a variety of cells in response to stimuli, such as bacterial lipopolysaccharide, with a strong chemotactic activity on neutrophils. Increased plasma IL-8 has been observed in patients with severe infections as well as in alcoholic and nonalcoholic cirrhotic patients (2)(3). To our knowledge, IL-8 production in ascitic fluid in cirrhotic patients developing SBP has not been determined. The aim of this study was to evaluate (a) IL-8 production in both plasma and ascitic …