Marker For Spontaneous Bacterial Peritonitis Research Articles

Use of Bacterial DNA Concentration in Ascites as a Marker for Spontaneous Bacterial Peritonitis

Background & AimsSpontaneous bacterial peritonitis (SBP) is a common and serious complication in patients with decompensated cirrhosis. Precise quantification of bacterial DNA (bactDNA) and the related inflammatory response might add further information on the course of disease. The aim of the study was to evaluate the association between bactDNA, cytokine levels and clinical outcome. MethodsAscites and serum samples of 98 patients with decompensated liver cirrhosis (42 with SBP and 56 without SBP) as well as serum samples of 21 healthy controls were collected. BactDNA in ascites and serum was detected and quantified by 16S rRNA PCR. Concentrations of IL-1β, TNF-α, IL-6, IL-8 and IL-10 were measured by a LEGENDplexTM multi-analyte flow assay. Clinical data were collected and analyzed retrospectively. ResultsBactDNA was detected more frequently in ascites of patients with SBP (n=24/42; 57.1%) than in ascites of patients without SBP (n=5/56; 8.9%; p < 0.001). Additionally, IL-6 levels in both ascites and serum were significantly higher in patients with SBP (ascites p < 0.001, serum p = 0.036). The quantity of bactDNA in ascites was strongly correlated with polymorphonuclear neutrophil count in ascites (r = 0.755; p < 0.001) as well as ascites IL-6 levels (r = 0.399; p < 0.001). Receiver operating characteristic (ROC) curve analysis to diagnose SBP provided an AUC of 0.764 (95% CI: 0.661 – 0.867) for serum IL-6 levels, an AUC of 0.810 (95% CI: 0.714 - 0.905) for ascites IL-6 levels, and an AUC of 0.755 (95% CI: 0.651 – 0.858) for bactDNA levels in ascites. ConclusionsThe correlation between the amount of bactDNA and IL-6 confirms the pathophysiological relevance of bactDNA and IL-6 as potential biomarkers for the diagnosis of SBP.

Ascitic Fluid Calprotectin as an Accurate Diagnostic Marker for Spontaneous Bacterial Peritonitis

Ascitic Fluid Calprotectin as an Accurate Diagnostic Marker for Spontaneous Bacterial Peritonitis

Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study

BackgroundThe neutrophil percentage-to-albumin ratio (NPAR) is a novel measure of systemic inflammation and infection. Low albumin levels increase the risk of infection, while high neutrophil counts indicate the presence of infection. Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic ascites, and the potential of NPAR in diagnosing SBP is not yet established.ObjectiveThe objective of this study is to determine the diagnostic value of NPAR in identifying SBP.PatientsThis prospective multicenter study included 465 patients diagnosed with cirrhotic ascites and SBP according to international guidelines. Demographic, clinical, and laboratory data were collected. The sensitivity and specificity of NPAR values for diagnosing SBP were assessed using the receiver operating characteristic curve.ResultsFor SBP diagnosis in the total cohort, NPAR of > 17 had a sensitivity of 85.71%, specificity of 66.67%, and 95% CI (42.1–99.6). In culture-positive SBP, the NPAR at a cut-off > 5.2 had a sensitivity of 85.71%, specificity of 83.33%, and 95% CI (0.709 to 0.979), while in culture-negative SBP, the NPAR at a cut-off > 2.1 had a sensitivity of 92.86%, specificity of 33.33% and CI (0.367 to 0.764). The multivariate analysis revealed that albumin (OR = 2.78, [1.11;3.98], INR (OR = 0.198, [0.066;0.596], creatinine (OR = 0.292, [0.1; 0.81], CRP (OR = 3.18, [1.239;4.52] total leukocytic count (TLC) (OR = 1.97, [1.878; 2.07], platelets (OR = 2.09, [0.99; 2.31] and neutrophil (OR = 3.43, [1.04;3.89] were significantly associated with higher prediction rates for culture positive SBP.ConclusionsNPAR could be a new, affordable, noninvasive test for diagnosing SBP.

Amyloid A in Serum and Ascetic Fluid as a Marker of Spontaneous Bacterial Peritonitis

Abstract Background Esophageal varices (EV) are a major complication of cirrhosis secondary to the development of clinically significant portal hypertension EV can lead to life-threatening bleeding, further decompensation and death among patients with cirrhosis. Aim of the Work The aim of this study is to assess the role of the clinical usefulness of the Amyloid A (serum and ascetic fluid) in patients with ascites (liver cirrhosis) and as a diagnostic marker for Spontaneous Bacterial Peritonitis. Patients and Methods This prospective study was conducted on 240 cirrhotic patients selected randomly presented for screening for esophageal varices at Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital Hospitals and at Kafr El- Shiekh Liver Research center Results The cause of cirrhosis was HCV in 205 patients (85.42%), HBV in 14 patients (5.83%), BHF in 47 patients (19.58%) with, AIH in 6 patients (2.5%) and other diseases in 21 patients (8.75%). the prevalence of oesophageal varices and its staging were 55 patients (22.9%) had no oesophageal varices, 44 patients (18.3%) had esophageal varices grade I-II (Small EVs) and 141 patients (58.8%) had oesophageal varices grade III-IV (Large EVs). According to Child-Pugh (CP) Score, 129 (53.75%) patients were Child A, 72 (30%) patients were Child B and 39 (22.9%) patients were Child C. ALBI ranged from -3.2 - (-0.42) with mean value −1.94 ± - 0.74. 67 (27.9%) patients were ALBI 1, 100 (41.7%) patients were ALBI 2 and 73 (30.4%) patients were ALBI 3. 50 (20.83%) patients were ALBI-PLT 2, 30 (12.5%) patients were ALBI-PLT 3, 88 (36.67%) patients were ALBI-PLT 4, 72 (30.0%) patients were ALBI-PLT 5. There was a significant difference among cirrhotic patients regarding EVs as regard to hemoglobin, platelets, APRI, albumin, total bilirubin, ALBI, ALBI-PLT, INR, Child-Pugh (CP) score, platelet count/spleen diameter ratio, spleen size and ascites (P &amp;lt; 0.001). Regarding the presence of EV, ALBI, ALBI-PLT, Child-Pugh (CP) Score and platelet count/spleen diameter ratio, are good predictors for the presence of oesophageal varices. ALBI at cut-off &amp;gt;-2.6 can predict oesophageal varices with sensitivity 83.77, specificity 53.06, PPV 87.4, NPV 45.6, AUC 0.711 and P-value &amp;lt;0.001, ALBI- PLT at cut-off &amp;gt;2 can predict oesophageal varices with sensitivity 96.48, specificity 87.76, PPV 96.9, NPV 97.7, AUC 0.982 and P-value &amp;lt;0.001. Regarding differentiation between Small EVs and large EVs, This study showed that ALBI, ALBI-PLT, Child-Pugh (CP) Scores, platelet count/spleen diameter ratio, spleen size and APRI could be used in prediction of the size of EVs, ALBI at cut-off &amp;gt;-2.03 can predict the size with sensitivity 95.28, specificity 93.75, PPV 96.8, NPV 90.9, AUC 0.971 and Pvalue &amp;lt;0.001. Conclusion Combined ALBI grade and platelet count (ALBI-PLT score), albumin-bilirubin ratio (ALBI), could be used as a serum non-invasive marker of the presence of oesophageal varices which may help in reducing unnecessary endoscopies and a good selection of patients who need an endoscopy to decrease intervention and burden on endoscopy units.

Ascitic procalcitonin as a diagnostic and prognostic marker of spontaneous bacterial peritonitis

Abstract Background SBP is a condition that requires a high index of suspicion, rapid and accurate diagnosis in addition to prompt and effective therapy. It is also characterized by a high recurrence rate within one year of the 1st episode. Objective Evaluation of ascitic fluid procalcitonin as a possible diagnostic and prognostic marker for spontaneous bacterial peritonitis and to study its role in diagnosis of SBP with no increase in the neutrophil count (where neutrophils in the ascitic fluid are less than 250 per ccm while the culture is positive). Patients and Methods Study was conducted at Hepatology and Gastroenterology Department in Ahmed Maher Teaching Hospital and Internal Medicine Department in Ain Shams University from January 2019 till July 2019. Total number of 50 patients with cirrhotic ascites entered this study were divided into three groups: Group A (patient group): 20 patients with SBP as diagnosed by 250 neutrophils or greater per cmm of the ascitic fluid as present in the guidelines. Group B (patient group): 20 patients with criteria suggestive of SBP (abdominal pain, fever, liver function deterioration, leukocytosis in the CBC with no other localization for the infection), but shows neutrophil count in the ascitic fluid less than 250 i.e not diagnostic by itself. Only Patients with positive culture will be included in this group. Group C (control group): 10 patients with ascites,but no evidence of SBP (symptomatic or laboratory) as the control. Results Ascitic fluid procalcitonin level was statistically significant higher in both groups A&amp;B (SBP group) than group C (non-SBP group). As regards Group A VS Group B+ Group C: The cutoff point is 520 (pg). Its sensitivity is 95%. Its specificity is 53.3%. The AUC is 0.633. The positive predictive value is 57.6%. The negative predictive value is 94.1%. Regarding Group B VS Group C: The cut-off point is 300 (pg). Its sensitivity is 85%. Its specificity is 70%. The AUC is 0.823. The positive predictive value is 85%. The negative predictive value is 70%. Conclusion Ascitic fluid procalcitonin had high sensitivity and specificity in diagnosis of SBP. Procalcitonin is valuable in diagnosis and prognosis of SBP. Procalcitonin is more useful as inflammatory marker than in infections

Predictive value of serum chemerin and nafld fibrosis score to ultrasonographic detection and quantification of steatosis in nonalcoholic fatty liver disease patients

Abstract Background It is difficult to diagnose spontaneous bacterial peritonitis (SBP) early in ascitic patients. Procalcitonin (PCT) is inflammatory marker used to diagnose severe bacterial infections. We evaluated the diagnostic role of this marker for spontaneous bacterial peritonitis (SBP) associated with liver cirrhosis. The aim of the study was to measure serum procalcitonin (PCT) levels to obtain an early diagnostic indication of SBP in ascitic patients. Methods A total of 90 patients diagnosed with liver cirrhosis devided in to three groups: Group (A):including 30 patients with SBP, Group (B) including 30ascitic patients without SBP and Group (C): including 30cirrhotic patients without ascites, groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels. Results Serum procalcitonin levels were determined to be significantly higher in patients with SBP compared to patients without SBP (median (min-max): 0.93 (0.4 - 1.23)vs. 0.13 (0.08 - 0.2), p = 0.100). Using ROC analysis, a serum procalcitonin level of &amp;gt; 0.315ng/mL (area under curve (AUC): 0.919, sensitivity: 87%, specificity: 97%, positive predictive value 96% and negative predictive value 88%) were determined to accurately help the diagnosis of spontaneous bacterial peritonitis. Conclusion According to our findings, determination of serum procalcitonin levels seems to provide accurate and rapid diagnosis of ascitic fluid infection.

Sirotik Hastalarda ve Spontan Bakteriyel Peritonitte Fekal Calprotectin Düzeylerinde Artış

Aim: The aim of this study is to investigate the relationship between fecal calprotectin (FC) which is a marker for intestinal inflammation and complications of cirrhosis which are due to increased bacterial translocation and intestinal inflammation.Material and Methods: Out of 156 cirrhotic patients aged between 18-80 years who are admitted to our hospital, 64 were excluded according to exclusion criteria and a total of 92 patients, and 20 volunteers with similar age and sex as a control group were included in this study. Serum samples were taken at admission to measure erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and white blood cell count (WBC). All patients and the control group provided a single stool sample within 24 hours after admission. The study group divided into five subgroups (Child-Pugh Grade A, Grade-B, Grade-C, spontaneous bacterial peritonitis and hepatic encephalopathy) to investigate whether FC levels change as the disease progress or complications occur.Results: Median FC levels were 168.8 mg/kg for cirrhotic patients and 9.8 mg/kg for control group, and the difference between the groups was statistically significant (p=0.039). In the subgroup analysis, the differences between spontaneous bacterial peritonitis and all other subgroups were statistically significant (p=0.002). In cirrhotic patients, FC levels were not correlated either with ESR (r=0.439, p=0.545) or CRP (r=0.403, p=0.321) or WBC count (r=0.061, p=0.645).Conclusion: FC levels are increased in cirrhotic patients and early increase in FC levels before the rise of systemic inflammation markers can be used as a diagnostic marker for spontaneous bacterial peritonitis.

The Ratio of Calprotectin to Total Protein as A Diagnostic Marker for Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis and Ascites

Background: Spontaneous bacterial peritonitis (SBP) is a potentially fatal condition, characterized by infection of ascitic fluid in absence of any intra-abdominal surgically treatable source of infection. Diagnosis of SBP is based on a differential ascites leucocytic count. Aim of the Work: to assess the role of ascitic fluid calprotectin in diagnosis of SBP. Patients and Methods: A cross-sectional study was conducted on 60 patients with decompensated liver disease were selected. They were divided into: 1) Non-SBP Group: included 30 patients with cirrhotic ascites without clinical or laboratory evidence of spontaneous bacterial peritonitis. 2) SBP Group: included 30 patients with cirrhotic ascites and spontaneous bacterial peritonitis. Results:. Ascitic fluid calprotectin level and the ratio of calprotectin to total protein was statistically significantly higher in the SBP group than the non-SBP group. There was a significant decrease in total protein and albumin in ascitic fluid in SBP group compared to the non-SBP group.A significant positive correlation was detected between ascitic fluid calprotectin and ascitic fluid TLC and PNLs among SBP group, A significant positive correlation between the ratio of calprotectin to total protein and ascitic fluid TLC and PNLs among SBP group. Ascitic fluid calprotectin at cut-off value 96 ng/ml, had a sensitivity of 86.67 % and a specificity of 76.67 % in the diagnosis of SBP with positive predictive value 85.2 % and negative predictive value 78.8%. - The ratio of calprotectin to total protein at cut-off value 9.6, had a sensitivity of 96.67 % and a specificity of 90 % in the diagnosis of SBP with positive predictive value 96.4 % and negative predictive value 90.6%. Conclusion: The ratio of calprotectin to total protein had high sensitivity and specificity in the diagnosis of SBP and better than calprotectin alone. The ratio of calprotectin to total protein could be a useful diagnostic test for SBP.

Ascitic calprotectin as a diagnostic marker for spontaneous bacterial peritonitis in hepatitis C virus cirrhotic Egyptian patients

BackgroundThe gold standard for the diagnosis of spontaneous bacterial peritonitis (SBP) is a polymorphonuclear leukocyte (PMNL) count of 250/mm3or more. Accurate and early diagnosis of SBP is important to decrease the mortality and complications in patients with cirrhosis.AimsThe aim of this study was to evaluate the accuracy of ascitic fluid calprotectin as a diagnostic marker for the detection of SBP.Patients and methodsSeventy Egyptian patients with liver cirrhosis and ascites were enrolled; these patients were divided into two groups: 50 patients with SBP and 20 patients with no SBP on the basis of an elevated ascitic PMNL count of 250 cells/mm3 or more. Ascitic samples were examined for PMNL count, culture, chemistry, and calprotectin concentrations in all patients.ResultsCalprotectin levels in ascitic fluid were correlated significantly with PMNLs and significantly higher in patients with SBP than non-SBP (P<0.001), with the best cutoff value for the detection of SBP of 783 ng/ml with a sensitivity, a specificity, a positive predictive value and negative predictive value, and an accuracy of 90, 100, 100, 80, and 92.9%, respectively.ConclusionElevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of SBP and considered a surrogate marker for PMNL.

Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients

BACKGROUND and AIM: Delayed diagnosis of spontaneous bacterial peritonitis (SBP) is associated with high mortality in cirrhotic patients. Therefore, there is a need for a rapid non-invasive diagnostic tool. This work aimed at evaluating the role of serum calprotectin as a non-invasive diagnostic marker for SBP in comparison to C-reactive protein (CRP). METHODS: 75 cirrhotic patients were included and divided into three groups. Group A: 25 patients with cirrhotic ascites and SBP diagnosed by presence of PMNL ≥ 250/mm 3 in ascitic fluid with or without positive ascitic fluid culture. Group B: 25 patients with cirrhotic ascites without SBP. Group C: 25 cirrhotic patients with no clinical or ultrasound evidence of ascites as a control group. All were subjected to complete clinical evaluation, routine laboratory investigations, serum calprotectin, CRP levels and diagnostic abdominal paracentesis (only for group A and B). RESULTS: Group A showed significantly higher levels of ascitic fluid total leukocytic count, polymorphonuclear leukocytes and total protein (P<0.001) in comparison to Group B. Group A had significantly higher serum calprotectin and CRP levels than other groups. There were significant positive correlations between serum calprotectin and serum WBC, CRP and ascitic fluid TLC, PMNL and total protein among group A. Serum calprotectin and CRP had the most significant diagnostic performance in detection of SBP (AUC=0.976 and 1.000 respectively, P<0.001). A cut-off level of serum calprotectin≥46.0 μg/mL showed a sensitivity of 100%, specificity 92% and diagnostic accuracy 96%; while that of CRP≥9.0 mg/dL showed a sensitivity of 100%, specificity 100% and diagnostic accuracy 100%. CONCLUSION: Serum calprotectin in combination with CRP may be useful for non-invasive diagnosis of SBP.

Ascitic Calprotectin is a Novel and Accurate Marker for Spontaneous Bacterial Peritonitis.

Spontaneous bacterial peritonitis (SBP) is a known complication of advanced cirrhosis and presents a high mortality rate. A polymorphonuclear (PMN) cell count >250/μl in the ascitic fluid is the current gold standard for diagnosing SBP. We evaluated the accuracy of a point-of-care test (POCT) for ascitic calprotectin in diagnosing patients with SBP. Eighty-eight patients admitted with decompensation of liver cirrhosis were studied including 41 patients (46.6%) with SBP. Ascitic calprotectin was measured using a quantitative POCT developed by Bühlmann® . Calprotectin levels correlated with PMN cell count and other inflammatory markers and were significantly higher in patients with SBP. An optimal cutoff of calprotectin above 1.57 μg/ml presented high sensitivity (87.8%), specificity (97.9%), and positive (97.3%) and negative (90.2%) predictive values for diagnosing SBP. Using calprotectin selectively in patients with a serum albumin-ascites gradient above 11 g/l further increased the sensitivity and negative predictive values of the test. Ascitic calprotectin appears to be a reliable method for diagnosing SBP in patients with liver cirrhosis. It may present an alternative to other conventional diagnostic methods.

The ratio of calprotectin to total protein as a diagnostic and prognostic marker for spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites.

Diagnosis of spontaneous bacterial peritonitis (SBP) is based on a differential ascites leukocyte count which does not provide prognostic information. We performed a pilot study to assess calprotectin in ascites as an alternative diagnostic and prognostic marker. We collected ascites from patients with liver cirrhosis from March 2012 to July 2013. Routine clinical and laboratory data of the patients were recorded. Ascites calprotectin levels were determined by ELISA. Overall, we collected 120 ascites samples from 100 patients with liver cirrhosis and from eight patients with malignant peritoneal effusion as disease control. Samples without infection had significantly lower calprotectin levels (median 34 ng/mL, range 5-795) than SBP samples (median 928 ng/mL, range 21-110,480; p<0.001) and malignant effusions (median 401, range 47-2596 ng/mL; p<0.001). In non-infected ascites, calprotectin levels were higher in Child-Pugh stage B versus C (median 57 ng/mL vs. 17 ng/mL; p<0.001) and in alcoholic versus viral cirrhosis (median 37 ng/mL vs. 10 ng/mL; p=0.015). The ratio of ascites calprotectin to total protein was a better marker for SBP than calprotectin alone (AUROC=0.93; p<0.001; sensitivity 93%, specificity 79%; positive predictive value 60%; negative predictive value 97%). In addition, high levels of the ratio to total protein were associated with poor 30-day survival (p=0.042). The ratio of ascites calprotectin to total protein may be a promising new diagnostic and prognostic marker in patients with liver cirrhosis and SBP and should be evaluated further.

Ascitic Fluid Lactoferrin as a Diagnostic Marker for Spontaneous Bacterial Peritonitis

Background and study aim:: Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in patients with cirrhosis and ascites. The diagnosis of SBP is established when the ascitic fluid polymorphonuclear leukocyte (PMN) counts is ≥250 cells/ mm3 with or without a positive ascitic fluid culture but this test lack sensitivity. The objective of this study was to evaluate the possible role of lactoferrin in diagnosis of SBP. Patients and methods: The study included seventy patients with liver cirrhosis and ascites admitted to hospital. Patients were classified into SBP group and control group by ascetic fluid PMN count. Aspirated ascitic fluid samples were examined for bacteriological culture, biochemical assay, and cytological count. Ascitic fluid lactoferrin was measured by ELISA technique Results :Ascitic fluid lactoferrin was significantly increased in SBP patients compared to control group. There was a statistically significant positive correlation between lactoferrin levels and PMN counts in SBP patients (p<0.001). ROC curve was used to determine a cutoff value for lactoferrin in diagnosis of SBP. At lactoferrin level ≥270 ng/ml, the sensitivity was 96%, specificity was 95%, positive predictive value was 97.96%, negative predictive value was 90.5%, and accuracy was 95.7% in diagnosis of SBP. Conclusion : Measurement of ascitic fluid lactoferrin could serve as a rapid and reliable screening tool for diagnosis of SPB.