Potential Preventability of Spontaneous Bacterial Peritonitis

“…Also incidence of SBP ranges from 10% to 30%. [2,3] Ascites fluid infection (AFI) can be lead to increase the mortality up to four hold in this patients. [4] The clinical presentation of SBP is quite variable.…”

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confidence: 99%

Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients With Culture Negative Neutrocytic Ascites

Barutçu¹

2021

Sisli Etfal

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A scites is the most common complication and reason of the hospitalization in the cirrhotic patients. Almost 60% of patients with cirrhosis will develop ascites within 10 years after diagnosis of the disease. [1] Cirrhotic patients with ascites are generally prone to developing bacterial infection of ascitic fluid. The prevalence of spontaneous bac- Objectives:The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients. Methods: This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5 th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated. Results: Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 10³/µL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001). Conclusion: Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response.

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“…Primary antibiotic prophylaxis has also been recommended in patients with low protein in ascitic fluid as there is an understanding that it improves incidence of infections and short-term survival[24,25]. However, adherence to these guidelines is low, and in part may be due to fears over antimicrobial resistance and reduced effectiveness over time[26,27]. An objective immune function biomarker that could highlight patients with the most severe immune-deficiency could enable the use of more targeted antibiotic prophylaxis to those most at risk of all infections, and not just SBP.…”

Section: Discussionmentioning

confidence: 99%

Immune function biomarker QuantiFERON-monitor is associated with infection risk in cirrhotic patients

Sood

Visvanathan

et al. 2016

WJH

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AIMTo investigate whether a novel immune function biomarker QuantiFERON-Monitor (QFM) can identify cirrhotic patients at greatest risk of infection.METHODSAdult cirrhotic patients on the liver transplant waiting list were recruited for this observational cohort study from a tertiary liver transplant referral unit. The immune function biomarker, QFM was performed using the same method as the widely available Quantiferon-gold assay, and measures output in interferon gamma in IU/mL after dual stimulation of the innate and adaptive immune systems. Ninety-one cirrhotic patients were recruited, with 47 (52%) transplanted on the day of their QFM. The remaining 44 (48%) were monitored for infections until transplant, death, or census date of 1st February 2014.RESULTSCirrhotic patients express a median QFM significantly lower than healthy controls (94.5 IU/mL vs 423 IU/mL), demonstrating that they are severely immunosuppressed. Several factors including model for end stage liver disease, presence of hepatocellular carcinoma, bilirubin, international normalized ratio and haemoglobin were associated with QFM on univariate analysis. Disease aetiology did not appear to impact QFM. On multivariate analysis, only Child-Pugh score and urea were significantly associated with a patient’s immune function as objectively measured by QFM. In the 44 patients who were not transplanted immediately after their blood test and could be monitored for subsequent infection risk, 13 (29.5%) experienced a pre-transplant infection a median 20 d (range 2-182) post-test. QFM < 214 IU/mL was associated with HR = 4.1 (P = 0.01) for infection. A very low QFM < 30 IU/mL was significantly associated (P = 0.003) with death in three patients who died while awaiting transplantation (HR = 56.6).CONCLUSIONQFM is lower in cirrhotics, allowing objective determinations of an individual’s unique level of immune dysfunction. Low QFM was associated with increased susceptibility to infection.

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Potential Preventability of Spontaneous Bacterial Peritonitis

Abstract: Many cases of SBP could be prevented by adhering to the AASLD guidelines. GI hemorrhage is the most frequently overlooked indication for SBP prophylaxis. Studies identifying the reasons for non-adherence to guidelines and developing interventions to increase utilization are warranted.

Cited by 9 publications

References 32 publications

Factors associated with medication adherence in patients living with cirrhosis

Factors associated with medication adherence in patients living with cirrhosis

Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients With Culture Negative Neutrocytic Ascites

Immune function biomarker QuantiFERON-monitor is associated with infection risk in cirrhotic patients

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