Value of Different Diagnostic Markers in Spontaneous Bacterial Peritonitis in HCV Egyptian Cirrhotic Patients

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening infection occurring in 8% -30% of ascitic cirrhotic patients; different laboratory diagnostics play a pivotal role for rapid and effective management of SBP patients. Polymorphonuclear leucocytic (PMNLs) count in Ascitic fluid (AF) is the mainstay for the diagnosis, whereas the diagnostic role of alternative biomarkers is rather controversial. In many studies, serum lipopolysaccharide binding protein (LBP) was elevated and Complement 3 (C3) level was significantly consumed in AF of SBP patients. Objectives: To evaluate the diagnostic value of serum LBP and AF C3 in HCV-cirrhotics with SBP in relation to other well-established serum and AF markers. Patients and Methods: One hundred and twenty patients with HCV-cirrhosis and ascites were enrolled and consented: 50 patients with non-SBP ascites in group A and 70 ascitic patients diagnosed with SBP according to clinical suspicion and PMLs count in AF ≥ 250 cells/mm 3 in group B in addition to 15 healthy individuals considered as a control group. Serum LBP, CBC, kidney and liver function tests, CRP, fasting and 2 h PP blood glucose and HCV antibodies were measured. AF samples were sent for C3 level, culture, PMNLs count, LDH, CRP, total proteins and albumin. Results: In patients with SBP, the level of serum LBP was not significantly high (p > 0.05) with best cut off value at 0.4500 and poor AUC (<0.6) with low sensitivity and specificity (53. 3% & 57.7%, respectively). AF C3 was significantly reduced in AF (p < 0.001) with best cut off value at 144.2 and almost excellent AUC (0.889) with good sensitivity and specificity (82% & 84%, respectively). AF culture showed significant difference between both patients groups (p < 0.05) but with low sensitivity (33.3%). Serum and AF CRP and AF PMNLs count were of high significance in SBP diagnosis (p < 0.001). Conclusion: Serum LBP level showed low significance while AF C3 was significantly reduced in patients with SBP. AF culture showed significant difference between both groups but with low sensitivity while serum, AF levels of CRP and AF

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

“…Other biochemical findings in AF analysis confirmed the presence of infection like high LDH and low glucose. These findings were in accordance with that of Badawy et al [34] and EL-Motasem et al [35].…”

Ascitic Fluid Micro RNA 155 as a Biomarker for Spontaneous Bacterial Peritonitis

“…In our study, Disturbed conscious level, abdominal pain, fever and abdominal enlargement were the main clinical presentation in SBP patients (34,4 %, 21% , 18.8% and 15.6% respectively). This result was in agreement with El Motasem et al 19 As regard routine laboratory findings of the current study, it showed no significant statistical difference between both groups except for TLC in blood, PMN, platelets indices (MPV and PDW) and serum Na. These results were in agreement with Khorshed et al 7. In our study, CRP in blood with ESR levels were elevated in SBP group with high statistical significant difference (p<0.001) among both groups that agreed with Awad et al 20, this explained by activation of cytokine synthesis in response to circulating bacterial endotoxins as reported by El sadek et al, 21 .…”

Neutrophil Gelatinase-Associated Lipocalin (NGAL): An Early Dual Biomarker in Diagnosis of Ascitic Fluid Infection and Acute Kidney Injury in Liver Cirrhosis in a Tertiary Centre, Egypt

“…In contrast, none of ascitic samples of SBP group were culture positive [30]. This variation in isolation rates is mainly due to the relatively low concentration of bacteria in AF [31] as colony count in spontaneously infected ascites is approximately one microorganism per mL [28]. Additionally, discrepancies of culture results may be due to difference in culture techniques as some studies didn't use blood culture bottles [32].…”