No abstract

Background and study aim: Serotonin is a one of the monoamine neurotransmitters secreted by serotonergic nerve endings in multiple sites in the brain and gastrointestinal tract wall. The presence of serotonin receptors on hepatic stellate cells can cause contraction of these cells closing the sinusoidal fenestrae and raising the portal vein pressure. The aim of this work is to study the relation between free serotonin level and the presence of varices in patients with cirrhosis. Patients and Methods: This prospective case control study was carried out on 70 patients with liver cirrhosis attended or admitted to Hepatology Department in Shebein El-Kom Teaching Hospital within the period between May and October 2015. They divided into two groups: Group 1: 40 patients with varices diagnosed by upper GIT endoscopy. Group 2: 30 patients without varices. In addition, 20 healthy persons served as control group (Group 3). All subjects were subjected to full history taking, clinical examination and laboratory investigation including plasma free serotonin by Enzyme Linked Immunosorbant Assay (ELISA). Results: serum serotonin level in group I was significantly higher than group II and control group. Serum serotonin level was significantly correlated to esophageal varices grade, Child, MELD and updated MELD scores. It was also clear that serotonin level rises significantly with higher grades of esophageal varices. Conclusion: Free serotonin had a good power of prediction for development of varices and correlated well with severity of liver disease in patients with cirrhosis assessed by Child, MELD and updated MELD scores as well as OV grade.

Background: Spontaneous bacterial peritonitis is very common bacterial infection in patients with cirrhosis and ascites, when first described its mortality exceeded 90% but it has been reduced to approximately 20% with early diagnosis and treatment. Mannose-binding lectin (MBL) is an important protein of humoral innate immune system with multiple carbohydrate recognition domain , it is able to bind to sugar group displayed on the surface of wide range of micro organism and therepy provide first line defense, it is also occur activate complement MBL produced in liver in response to infection and is a part of many other factor termed acute phase protein. We aimed to study the level of ascitic fluid mannose binding lectin in patients with spontaneous bacterial peritonitis. Methods: This study was conducted on 90 patients with cirrhotic ascites with and without spontaneous bacterial peritonitis admitted to Benha University Hospital and Manshyet El Bakriy Hospital. They were classified into two groups, group (I) included 45 cirrhotic patients with spontaneous bacterial peritonitis (35 males and 10 females), aged between 36 -69 with a mean age of 52.96 ± 7.90 years while group (II) included 45 cirrhotic patients without spontaneous bacterial peritonitis (29 males and 16 females), aged between 28 -65 with a mean age of 49.49 ± 10.21 years. Results: Regarding the ascetic level of MBL in patients with SBP, it was found in this study that the mean value of MBL level was significantly lower in SBP group than non SBP group. There are statistically significant positive correlations between MBL and Bilirubin, prothrombin time, INR and u MELD values and significant negative correlations between MBL and Platelets and serum ascetic albumin gradient values among patients with SBP. In the present study, the ROC curve shows that the best cut off point for MBL to diagnose cases with ascites with SPB cases was found 1307 with sensitivity 75.56%, specificity of 77.78% and area under curve (AUC) of 77.0%. In this study, by multivariant analysis WBCs, RBCs, serum creatinine, ALT, serum albumin and MBL were significantly determining predictors for SBP positivity. Conclusion: The mean value of ascetic level of MBL was significantly lower in SBP group than non SBP group. Ascitic fluid MBL could be a good predictive and prognostic marker in patients with cirrhosis and spontaneous bacterial peritonitis.

Background: A common bacterial infection of ascitic fluid in ascites due to liver cirrhosis is spontaneous bacterial peritonitis. Human neutrophil granules release a 24 KDA glycoprotein called neutrophil gelatinase associated lipocalin (NGAL). (NGAL) is a tissue injury and infection marker. Aim: The aim of this study was to determine the amount of NGAL in ascitic fluid in patients with liver cirrhosis and spontaneous bacterial peritonitis. Methodologies: A total of 85 patients with cirrhotic ascites were included in the study. 42 of them had SBP. The severity of liver cirrhosis was assessed using the Child-Pugh score, the Model for End Stage Liver Disease (MELD), and its update (uMELD) scores. Ascitic fluid samples were collected for leucocytic count differentiation, albumin, protein, glucose estimation, and the serum-ascetic albumin gradient. Both patients had their NGAL levels measured in their ascitic fluid. If the polymorph-nuclear leucocytic count in ascitic fluid was more than 250/mm 3 , SBP was diagnosed. Results: The level of NGAL in ascitic fluid was significantly higher in patients with SBP. ROC analysis of ascitic NGAL as a marker for SBP diagnosis revealed: sensitivity of 97.62 percent, specificity of 97.67 percent, and area under curve (AUC) of 0.974 at a cut-off value of 100.8 (ng/dl). White blood cells, polymorph nuclear cells (PNCs) in ascitic fluid, Child Pugh score, MELD score and uMELD score all had a negative correlation with NGAL in non SBP group. Conclusion: In patients with spontaneous bacterial peritonitis, ascitic fluid NGAL may be a useful diagnostic marker.