A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections

Abstract

Background: The accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measurement of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which we called the PEC index. This crosssectional analytic study comprised 178 cirrhotic patients with ascites (60 patients with SBP and 118 patients with sterile ascites), after excluding non-SBP infection, during the period from March 2019 until September 2019. In all participants, serum levels of PCT, ESR, and CRP were measured, and PEC index was calculated [PEC index = PCT × (ESR + CRP)]. Results: Patients with SBP (n = 60) had significantly higher serum PEC index than those with sterile ascites (n = 118) (41.0/31.2-93.0 vs. 9.9/5.9-15.0, P < 0.001). PEC index distinguished culture positive cases significantly (P < 0.001). Using receiver operating characteristic (ROC) statistics, the sensitivity and specificity of PCT, at a cutoff value of 0.590 ng/mL, for SBP diagnosis, were 81.67% and 93.33%, respectively (area under the curve [AUC] = 0.879; 95% confidence interval [CI] 0.809-0.948). The sensitivity and specificity of ESR, at a cutoff value of 27.0 mm/hour, were 73.33% and 61.67%, respectively (AUC = 0.679; 95% CI 0.581-0.776). The sensitivity and specificity of CRP, at a cutoff value of 21.0 mg/L, were 93.33% and 51.67%, respectively (AUC = 0.736; 95% CI 0.639-0.833). While, the sensitivity and specificity of PEC index, at a cutoff value of 20, were highest (98.33% and 96.67%, respectively, AUC = 0.977; 95% CI 0.940-0.996). Conclusion: Serum PEC index makes an accurate noninvasive diagnosis of SBP, after excluding other infections.

Macrophage Inflammatory Protein Type 1 Beta as a Novel Diagnostic Marker for Diagnosis of Spontaneous Bacterial Peritonitis

“…As regards acute inflammatory marker C reactive protein (CRP) in serum, the current study showed a significant increase in SBP versus none SBP group. This result matched with previous results 7,9,[12][13][14][15] .…”

Serum Homocysteine as an Early Diagnostic Marker of Spontaneous Bacterial Peritonitis in Patients with Hepatic Cirrhosis

“…Concerning ascitic fluid parameters between the two studied groups, ascitic fluid glucose and albumin were significantly lower in SBP group (P=0.002 & P=0.027, respectively) while LDH and PMN count were significantly higher in SBP group (P<0.001, for both). These results are in agreement with the results of the study of Elsadek et al (17) , which showed that comparison between SBP group (n = 60) and sterile ascites group (n = 118) regarding demographic, clinical, and laboratory characteristics revealed significantly higher ESR, and CRP, as well as significantly higher AF LDH and PMNs count in SBP group (P < 0.001, for all parameters). On the other hand, Kim et al (18) reported that there were no significant differences in the laboratory findings, including the neutrophil count in the ascites, between the groups.…”

Blood Neutrophil / Lymphocyte Ratio and C –Reactive Protein / Albumin Ratio as Markers of Response for Treatment of Spontaneous Bacterial Peritonitis

“…On the other hand, the C reactive protein was found to be significantly elevated in the SBP group agreeing with Khorshed et al, & Elsadek et al, In contrast, Pieri et al, found that the basic level of CRP in cirrhotic patients was higher than in non-cirrhotic patients, but once infection occurs, it is probably worse the liver function more, leading to less increase in the CRP and also Janum et al, who concluded that the power of CRP to predict infection is weak in patients with advanced cirrhosis [15][16][17][18].…”