Ascitic Fluid Lactoferrin for Diagnosis of Spontaneous Bacterial Peritonitis

Parsi, Mansour A.; Saadeh, Sherif; Zein, Nizar N.; Davis, Gary L.; López, Rocío; Boone, James H.; Lepe, Maria R.; Guo, Li; Ashfaq, Mohammad; Klintmalm, Göran; McCullough, Arthur J.

doi:10.1053/j.gastro.2008.05.045

Cited by 81 publications

(64 citation statements)

References 28 publications

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“…Furthermore, in those patients not clinically responding to SBP treatment, repeat paracentesis with cell count and differential studies may be performed to provide a rapid prognostic tool [5] . Other noncellular inflammatory markers in SBP have been studied as well, including ascitic fluid lactoferrin, with productive results [37,38] . Interestingly though, even in non-infected cirrhotic patients with portal hypertensive ascites, there seems to be a significant degree of cellular and cytokine inflammation [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have documented a number of pro-and anti-inflammatory markers in the serum and ascitic fluid of such patients [17,18] . Furthermore, an immune response, both innate and adaptive, can be generated and exacerbated by a network of immunocytes sampling bacterial antigens in the enteric mucosa or after BT [29][30][31][32][33][34][35][36][37] . These processes are in a dynamic equilibrium, wherein a particular arrangement of inflammatory markers, both in the serum and ascitic fluid, interacts with a critical load of bacterial antigen.…”

Section: Discussionmentioning

confidence: 99%

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Procalcitonin, and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites

Attar

Moore

George

et al. 2014

WJG

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Procalcitonin, and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites

Attar

Moore

George

et al. 2014

WJG

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“…When there is a predominant lymphocytosis in the ascitic fluid, the differential diagnosis must include tuberculous peritonitis, neoplasms, congestive heart failure, pancreatitis and myxedema, but usually not SBP [18] . Other markers that have been suggested for the diagnosis of SBP are lactoferrin, an iron-binding protein contained in PMN, which has a sensitivity of 96% and a specificity of 97% with cut-off value of ≥ 242 ng/mL in ascitic fluid [27] . The most frequently identified organisms in patients with SBP are gram-negative bacteria (E. coli) and grampositive cocci (streptococcus and enterococcus).…”

Section: Diagnosis Of Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Diagnosis and management of bacterial infections in decompensated cirrhosis

Pleguezuelo

Benítez²,

Jurado³

et al. 2013

WJH

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Bacterial infections are one of the most frequent complications in cirrhosis and result in high mortality rates. Patients with cirrhosis have altered and impaired immunity, which favours bacterial translocation. Episodes of infections are more frequent in patients with decompensated cirrhosis than those with compensated liver disease. The most common and life-threatening infection in cirrhosis is spontaneous bacterial peritonitis followed by urinary tract infections, pneumonia, endocarditis and skin and soft-tissue infections. Patients with decompensated cirrhosis have increased risk of developing sepsis, multiple organ failure and death. Risk factors associated with the development of infections are severe liver failure, variceal bleeding, low ascitic protein level and prior episodes of spontaneous bacterial peritonitis (SBP). The prognosis of these patients is closely related to a prompt and accurate diagnosis. An appropriate treatment decreases the mortality rates. Preventive strategies are the mainstay of the management of these patients. Empirical antibiotics should be started immediately following the diagnosis of SBP and the first-line antibiotic treatment is third-generation cephalosporins. However, the efficacy of currently recommended empirical antibiotic therapy is very low in nosocomial infections including SBP, compared to community-acquired episodes. This may be associated with the emergence of infections caused by Enterococcus faecium and extended-spectrum β-lactamaseproducing Enterobacteriaceae, which are resistant to the first line antimicrobial agents used for treatment. The emergence of resistant bacteria, underlines the need to restrict the use of prophylactic antibiotics to patients with the greatest risk of infections. Nosocomial infections should be treated with wide spectrum antibiotics. Further studies of early diagnosis, prevention and treatment are needed to improve the outcomes in patients with decompensated cirrhosis.

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“…Markers such as ascitic pH or lactate were successfully used in some studies, but have been discontinued as of today (33,34).…”

Section: Diagnostic Paracentesis and Cell Countmentioning

confidence: 99%