Ascitic Fluid Calprotectin and Serum Procalcitonin as Accurate Diagnostic Markers for Spontaneous Bacterial Peritonitis

Abstract

Background/AimsThe diagnosis of spontaneous bacterial peritonitis (SBP) is based on a polymorphonuclear leukocytes (PMNs) exceeding 250/μL in ascitic fluid. The aim of the study was to evaluate serum procalcitonin and ascitic fluid calprotectin as accurate diagnostic markers for detecting SBP.MethodsSeventy-nine patients with cirrhotic ascites were included. They were divided into a SBP group, including 52 patients, and a non-SBP group of 27 patients. Serum procalcitonin, ascitic calprotectin, and serum and ascitic levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured using an enzyme-linked immunosorbent assay.ResultsSerum procalcitonin and ascitic calprotectin were significantly higher in SBP patients than in non-SBP patients. Significant increases in both serum and ascitic levels of TNF-α and IL-6 were observed in SBP patients versus non-SBP patients. At a cutoff value of 0.94 ng/mL, serum procalcitonin had 94.3% sensitivity and 91.8% specificity for detecting SBP. In addition, at a cutoff value of 445 ng/mL, ascitic calprotectin had 95.4% sensitivity and 85.2% specificity for detecting SBP. Both were positively correlated with ascitic fluid proteins, PMN count, TNF-α, and IL-6.ConclusionsAccording to our findings, determination of serum procalcitonin levels and ascitic calprotectin appears to provide satisfactory diagnostic markers for the diagnosis of SBP.

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

“…This study aimed at evaluating the role of serum calprotectin as a non-invasive diagnostic marker for SBP in Egyptian cirrhotic patients in comparison to CRP. Regarding the ascitic fluid cell count in the current study, there were higher levels of ascitic TLC and PMNL count in SBP group in comparison to the group with sterile cirrhotic ascites, and this result is in agreement with Girón-González et al (16) , Yildirim et al (17) and Abdel-Razik et al (18) . As regards ascitic fluid total protein, it was significantly higher in SBP group than in sterile cirrhotic ascites group (P<0.001).…”

“…In this study, there was no significant difference between SBP group and the group with sterile cirrhotic ascites as regards the ascitic fluid glucose, and this is in agreement with Bibi et al (22) . Regarding the relation between occurrence of SBP and Child-Pugh class, we found that 92% of patients with SBP were in Child C class compared to 76% of patients with sterile cirrhotic ascites, and this result is close to Abdel-Razik et al (18) who found that about 75% of the patients who developed SBP were in Child C class, with the remainder were in class B.…”

“…In this study, we found that high serum calprotectin level was significantly correlated with high ascitic fluid TLC and PMNL levels in SBP group. Also, Burri et al (6) , Abdel-Razik et al (18) , and Ali et al (23) , found that ascitic calprotectin levels were correlated well and reliably with ascitic PMNL counts, and the samples with PMNL > 250/μL also had higher ascitic calprotectin levels than the samples with PMNL ≤ 250/μL in their studies. The correlation between high serum & ascitic calprotectin with high ascitic TLC and PMNL levels can be explained by the study of Soyfoo et al (9) , who denoted that calprotectin presence in body fluids is proportional to the influx of neutrophils.…”

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

“…Calprotectin is a neutrophil‐derived protein found in both plasma and stool that is elevated in infectious and inflammatory conditions . Previous studies have suggested that ascitic calprotectin may be useful in diagnosing SBP in the setting of liver cirrhosis . In this paper we aimed to confirm these findings using a quantitative point‐of‐care test (POCT) to measure calprotectin in the ascitic fluid of patients with liver cirrhosis.…”

A Comparative Study on Ascetic Fluid Biochemical Markers in Cirrhotic Children with and Without Spontaneous Bacterial Peritonitis: A Cross-Sectional Observation

“…Accordingly, patients with AF infections have had higher levels of CRP (13,(15)(16)(17)(18). In addition to diagnostic benefits, CRP may also be applicable in predicting prognosis and mortality (19,20), as well as antibiotic response rate in SBP patients (3,21). Pro-inflammatory markers; TNF-α, IL-6, and calprotectin have been correlated with SBP clinical course (2).…”