Significance of Heparin-Binding Protein and D-dimers in the Early Diagnosis of Spontaneous Bacterial Peritonitis

Abstract

Objectives Ascites and spontaneous bacterial peritonitis (SBP) are among the most important complications of decompensated liver cirrhosis. In clinical practice, new inflammation biomarkers are needed for the early diagnosis of SBP, as well-known biomarkers, such as C-reactive protein (CRP), procalcitonin (PCT), or peripheral blood white blood cell (WBC) count, lack the required specificity and sensitivity. The aim of the study was to evaluate the significance of heparin-binding protein (HBP) in comparison to CRP, PCT, WBC, and D-dimers in the diagnosis of SBP. Design Cross-sectional descriptive single-center study. Setting Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Poland. Patients All patients admitted to the aforementioned department with decompensated liver cirrhosis and ascites between February 1, 2016, and June 30, 2017. Intervention Several markers (HBP, CRP, PCT, WBC, and D-dimers) were analysed in blood serum in regard to their potential use in the diagnosis of SBP in patients with decompensated liver cirrhosis and ascites. We correlated the levels of the aforementioned markers with an ascitic fluid polymorphonuclear count using simple linear regression and multiple linear regression. Sensitivities, specificities, and positive and negative predictive values for SBP were calculated for the aforementioned makers of inflammation. Measurements and Main Results A total of 63 patients with decompensated liver cirrhosis and ascites participated in the study. The etiology of liver cirrhosis was varied (HCV: n = 40, HBV: n = 13, HCV/HBV: n = 4, AIH: n = 3, PBC: n = 2, and haemochromatosis: n = 1). After the peritoneal tap, 31 patients were determined to have SBP (defined as an ascitic fluid polymorphonuclear count > 250 cells/μL) and 32 patients had no evidence of SBP on peritoneal tap. A very weak, but statistically significant, correlation of HBP, WBC, and D-dimer levels with the peritoneal fluid polymorphonuclear (PMN) count was observed in the simple regression model, but multivariable analysis using the multiple regression model showed that only D-dimers correlated with peritoneal fluid PMNs independently from other inflammation biomarkers. A D-dimer cutoff value of 1500 ng/mL was determined optimal for ruling out SBP due to high sensitivity (96.8%) and a high negative predictive value (92.9%), although predictably, this marker was not useful for confirming SBP due to low specificity (40.6%) and a low positive predictive value (61.2%). The usefulness of D-dimers was limited by the fact that only 22.2% of the studied patients had D-dimer levels below 1500 ng/mL. HBP and WBC showed little to no predictive value in this study. Conclusions D-dimers < 1500 ng/mL make the diagnosis of SBP unlikely, although the peritoneal tap is still the reference method in such situations. In the studied group, the determination of HBP was of no diagnostic benefit in the diagnosis of SBP.

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

“…The search for a non-invasive and readily available biomarker for unmistakable diagnosis of SBP in cirrhotic patients with ascites, is still under clinical trials [22,23,29,30,32,33]. The current work, to the best of our knowledge, is the first to characterize the use of indexed combined measurement of serum PCT, ESR, and CRP for this purpose, after exclusion of non-SBP bacterial infections.…”

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

“…These reasons prompted many researchers constantly looking for new markers capable of predicting periprosthetic infection. D-dimer is a biomarker of disseminated intravascular coagulation and also increases in inflammation, thrombosis, and neoplastic disorders [12]. D-dimer has been widely used in the diagnosis of infection and the evaluation of patients' prognosis.…”

“…In the prospective study, Schwameis et al [30] found that within 3.5 hours of early bacteremia, rapidly elevated D-dimer level could identify bacteremia and assess the prognosis and mortality in advanced septic shock. A D-dimer cutoff value of 1500 ng/mL had high sensitivity (96.8%) and high NPV (92.9%) for detecting spontaneous bacterial peritonitis; thus, Mikula et al [12] considered that it was significantly better than other inflammatory markers (white blood cell, CRP, and procalcitonin). In addition, D-dimer is recommended as a key diagnostic marker for infectious diseases such as endocarditis and mycoplasma pneumonia [29,31].…”

“…Thus, the application of D-dimer as an infection biomarker might be a possible benefit from this knowledge. D-dimer is a specific marker of fibrinolysis and also increases in inflammation, thrombosis, or neoplastic disorders [12]. Recently, it has been reported that plasma D-dimer level can be used as an inflammatory factor for the diagnosis of PJI, as well as timing of reimplantation [13].…”

Diagnostic Accuracy of D-Dimer in Periprosthetic Joint Infection: a diagnostic meta-analysis

“…Given this situation, there is an urgent demand for joint surgeons to look for diagnostic markers with e ciency, cheapness, and convenience [13]. D-dimer is a brin degradation product formed by brinolysis of brin clots, which re ects the state of blood coagulation and increases in systemic or local infections, thrombosis, and neoplastic diseases [14][15][16]. Based on this principle, Shahi et al And Li et al speculated that d-dimer in PJI patients might serve as a neoteric diagnostic biomarker [17,18].…”