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 cutoff 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.
Background and study aim: The most common infections in decompensated liver cirrhotic ascites patients are cases of spontaneous bacterial peritonitis (SBP), which account for 40%-70% of cases. SBP is a bacterial infection that occurs in absence of an evident intra-abdominal or surgically treatable source of infection. Patients and methods: This study was conducted on 80 patients with liver cirrhosis and ascites; 40 patients of them without SBP (group A) and 40 patients of them with SBP (group B) who were admitted to the Hepatology, Gastroenterology and Infectious Diseases Department, Benha University Hospital in the period between April 2014 and October 2014. Full history taking, clinical examination and laboratory investigation were done. Ascitic fluid analysis was done including detection of granulocyte elastase level. Results: Granulocyte elastase was markedly elevated in group B; mean ascitic fluid GE ELISA (4.1±2.8) comparing with group A (0.8±0.7) and it revealed a high statistically significant association between SBP and GE (P value <0.05). SBP was more common in child C. Fever, hypotension and abdominal pain were more common in SBP group. Conclusion: Granulocyte elastase is increased in cases of SBP, cutoff value of ascitic fluid (GE) for diagnosis of SBP at 0.88 ng/mL had 100% sensitivity, 75% specificity, 80% positive predictive value, 100% negative predictive value and 87.5% accuracy.
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