Ascitic Calprotectin, as a Potential Diagnostic and Prognostic Marker of Spontaneous Bacterial Peritonitis

Abstract

Background: The presence of an elevated absolute polymorphonuclear leukocyte count in the ascitic fluid (>250 cells/mm3) in combination with a positive ascitic fluid bacterial culture is diagnostic of spontaneous bacterial peritonitis. Among the families of calcium-binding proteins known as S100, calprotectin belongs to the subfamily known as calgranulins. Objective: The aim of the current work was to examine the value of ascitic fluid calprotectin for the diagnosis and prognosis of spontaneous bacterial peritonitis in people with liver cirrhosis. Patients and Methods: Between April 2018 and May 2019, 50 Egyptians with liver cirrhosis and ascites were recruited. Forty individuals with spontaneous bacterial peritonitis (SBP) and 10 patients with ascites without SBP were studied. Biochemical, bacterial, and ascitic calprotectin level, as well as diagnostic paracentesis, were performed to all patients. Results: When comparing individuals with cirrhosis and SBP to those without SBP, the level of calprotectin in the ascitic fluid was significantly higher in SBP patients (P= 0.000). Its mean values were statistically significantly reduced after treatment of SBP in comparison to its level before treatment [reduced from 626.75 ± 188.05 to 251.25 ± 223.13 ug/l] with p value 0.000. At a cutoff value of >320 ug/l, ascitic calprotectin may be a possible marker of development of SBP among cirrhotic patients with ascites with 95% sensitivity and 90% specificity. Conclusion: It could be concluded that ascitic fluid calprotectin may be useful in the diagnosis and prognosis of patients with liver cirrhosis and spontaneous bacterial peritonitis.

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

“…In agreement with our findings, Abd Ellatif Afifi et al (16) highlighted that calprotectin was substantially greater in SBP group contrasted to the group without SBP. In agreement with our results, Rasmy et al (15) highlighted that calprotectin were substantially elevated in SBP group contrasted to the group without SBP (P-value < 0.001). Also, Honar et al (20) revealed that calprotectin was substantially raised (P-value < 0.001).…”

“…In agreement with our findings, Abd Ellatif Afifi et al (16) highlighted that no substantial variation was existed among SBP and non SBP group as regard ( HB, AST, Albumin, TP, bilirubin creatinine, and urea). In line with our findings, Rasmy et al (15) highlighted that (HB, AST, Albumin, TP, bilirubin, creatinine, and urea) were insignificantly different between both studied groups. Parallel to our results, Abdel Rahman et al (18) noted that no substantial variation was existed among SBP group and the group without SBP regarding ( HB, AST, Albumin, TP, bilirubin, and creatinine).…”

“…The AUC for calprotectin was 0.91. Consistent with our findings, Rasmy et al (15) emphasized that when the ascitic calprotectin level exceeds 320 ug/l, it might potentially serve as an indicator for the onset of SBP in cirrhoticindividuals with ascites, with a sensitivity of 95% and specificity of 90%. Consistent with our findings, Heikl et al (21) emphasized that the threshold value of ascitic calprotectin for detecting SBP was 783 ng/ml.…”

“…All non-SBP patients had negative culture. Parallel to our results, Rasmy et al (15) highlighted that The positive culture cases consisted of the following: 13 (72.2%) cases of E coli, 2 (11.1%) cases of Streptococcus pneumoniae, 1 (5.5%) case of pseudomonas species, and 1 (5.5%) case each of Staphylococcus species and Enterococcus species. In agreement with our results, Ali and Mohamed.…”

“…In agreement with our findings, Rasmy et al . (15) highlighted that TLC, ALT, INR and CRP were substantially raised in serum in SBP group contrasted to the group without SBP (P-value < 0.05), while platelets were substantially reduced in SBP group contrasted to the group without SBP (P< 0.005). In agreement with our findings, Abd Ellatif Afifi et al (16) revealed that TLC, ALT, INR and CRP were substantially raised in serum in SBP group contrasted to the group without SBP (P-value < 0.05), while platelets were substantially reduced in SBP group contrasted to the group without SBP.…”