Disease dependent qualitative and quantitative differences in the inflammatory response to ascites occurring in cirrhotics

Attar, Bashar M.; George, Magdalena; Ion-Nedelcu, N; Ramadori, G; Thiel, David H. Van

doi:10.4254/wjh.v6.i2.85

Cited by 8 publications

(7 citation statements)

References 13 publications

(17 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 23 The usual absence of typical clinical characteristics in this patient population makes identification of SBP difficult. 24 An ascitic PMN count >250 cells/mm 3 is considered diagnostic of SBP and triggers immediate initiation an empirical antibiotic treatment. 3 Spontaneous bacterial peritonitis caused by Gram-positive cocci is associated with a PMN count below the threshold of 250 cells/mm 3 , because the stimulatory capacity for PMN migration depends on the type of bacteria.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

Yang¹,

Li²,

Qu³

et al. 2015

Medicine

View full text Add to dashboard Cite

Early diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. The aim of this study is to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease.After performing a systematic search of the Medline, Embase, and Cochrane databases for studies that evaluated the diagnostic role of PCT for SBP, sensitivity, specificity, and other measures of accuracy of PCT concentrations in serum for SBP diagnosis were pooled using random-effects models. A summary receiver operating characteristic curve was used to summarize overall test performance.Seven publications met the inclusion criteria covering 742 episodes of suspected SBP along with 339 confirmed cases. The summary estimates for serum PCT in the diagnosis of SBP attributable to end-stage liver disease were: sensitivity 0.82 (95% CI 0.79–0.87), specificity 0.86 (95% CI 0.82–0.89), positive likelihood ratio 4.94 (95% CI 2.28–10.70), negative likelihood ratio 0.22 (95% CI 0.10–0.52), and diagnostic OR 22.55 (95% CI 7.01–108.30). The area under the curve was 0.92. There was evidence of significant heterogeneity but no evidence of publication bias.Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

Yang¹,

Li²,

Qu³

et al. 2015

Medicine

View full text Add to dashboard Cite

show abstract

“…tumor necrosis factor (TNF), IL-2, IL-4, IL-6 and IL-8) are increased especially in patients with alcohol-related cirrhosis or in those with massive ascites. 48 Up-regulation of TLR2 and TLR4, and their pro-inflammatory mediators, activates hepatic stellate cells and enhances fibrosis, leading to the progression of liver cirrhosis and finally the development of hepatocellular carcinoma. 49 On the contrary, TLR4 expression is down-regulated in the peripheral blood mononuclear cells (PBMCs) of cirrhotics.…”

Section: Microbial Products and Host Reactionmentioning

confidence: 99%

Gut Microbiome-based Therapeutics in Liver Cirrhosis: Basic Consideration for the Next Step

Fukui

2017

JCTH

View full text Add to dashboard Cite

Infections account for significant morbidity and mortality in liver cirrhosis and most are related to the gut microbiome. Fecal dysbiosis, characterized by an overgrowth of potentially pathogenic bacteria and a decrease in autochthonous non-pathogenic bacteria, becomes prominent with the progression of liver cirrhosis. In cirrhotic patients, disruption of the intestinal barrier causes intestinal hyperpermeability (i.e. leaky gut), which is closely related to gut dysmotility, dysbiosis and small intestinal bacterial overgrowth and may induce pathological bacterial translocation. Although the involved microbial taxa are somewhat different between the cirrhotic patients from the East and the West, the common manifestation of a shortage of bacteria that contribute to the production of short-chain fatty acids and secondary bile acids may facilitate intestinal inflammation, leaky gut and gut dysbiosis. Translocated endotoxin and bacterial DNA are capable of provoking potent inflammation and affecting the metabolic and hemodynamic systems, which may ultimately enhance the progression of liver cirrhosis and its various complications, such as hepatic encephalopathy (HE), variceal bleeding, infection and renal disturbances. Among studies on the microbiome-based therapeutics, findings of probiotic effects on HE have been contradictory in spite of several supportive results. However, the effects of synbiotics and prebiotics are substantially documented. The background of their effectiveness should be evaluated again in relation to the cirrhosis-related changes in gut microbiome and their metabolic effects. Strict indications for the antibiotic rifaximin remain unestablished, although its effect is promising, improving HE and other complications with little influence on microbial populations. The final goal of microbiome-based therapeutics is to adjust the gut-liver axis to the maximal benefit of cirrhotic patients, with the aid of evolving metagenomic and metabolomic analyses.

show abstract

“…Consequently, an AF PMNL count ≥ 250/μL is considered for SBP diagnosis, regardless of culture results [12][13][14][15]. In considerable number of cases, the absence of typical clinical characteristics of SBP makes its identification difficult [16].Therefore, an early non-invasive diagnosis of SBP in DCPs is sometimes recommended, especially in cases with irrelevant clinical manifestations, those newly admitted to hospital, or those with unexplained shock or deterioration of their liver functions [2,3,16].…”

Section: Introductionmentioning

confidence: 99%

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

Elsadek

Elhawari

Mokhtar

2020

Egypt Liver Journal

View full text Add to dashboard Cite

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.

show abstract

Disease dependent qualitative and quantitative differences in the inflammatory response to ascites occurring in cirrhotics

Abstract: AIM:To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis (SBP).

Cited by 8 publications

References 13 publications

Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

Diagnostic Accuracy of Serum Procalcitonin for Spontaneous Bacterial Peritonitis Due to End-stage Liver Disease

Gut Microbiome-based Therapeutics in Liver Cirrhosis: Basic Consideration for the Next Step

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

Contact Info

Product

Resources

About