Comparative Study of Ascitic Fluid and Serum Levels of Calprotectin, Procalcitonin and Endocan in Patients With Liver Cirrhosis for Early Diagnosis and Prediction of Spontaneous Bacterial Peritonitis

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/? L.Objectives: polymorphonuclear leukocytes (PMNs) to be more than 250/? L. Objective: The aim of the study was to evaluate the ascitic fluid and serum levels of calprotectin, procalcitonin (PCT) and endocan as appropriate markers for predicting and diagnosing SBP.Patients and Methods: This study was conducted on 90 patients with liver cirrhosis: 35 with decompensated cirrhosis and spontaneous bacterial peritonitis, 35 with decompensated cirrhosis without spontaneous bacterial peritonitis and 20 with compensated cirrhosis with no ascites. We evaluate the correlations of calprotectin, procalcitonin and endocan with indicators of infection and inflammation associated with spontaneous bacterial peritonitis in liver cirrhotic patients. Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and polymorphonuclear leukocytes, serum CRP, and blood leukocytes were analyzed. The control group (n = 30) composed of healthy blood donors with normal aminotransferase levels, normal complete blood counts and negative markers for viral hepatitis and HIV.Results: Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and PMNs, serum CRP and blood leukocytes were statistically elevated in cirrhotic patients with SBP than the control group and cirrhotic patients without SBP. There were statistically significant correlations between the existence of SBP with serum calprotectin (r = 0.512), serum procalcitonin (r= 0.370), serum endocan (r = 0.501), ascitic calprotectin (r = 508), ascitic procalcitonin (r = 0.501), ascitic endocan (r = 0.496), ascitic PMNs (r = 0.562), and CRP (r = 0.492), for all P < 0.001. The diagnostic accuracies of calprotectin, endocan, procalcitonin, and PMNs were elevated in progressive disease stage. Ascitic PMNs ≥ 250/mm³ had a sensitivity of 97% and specificity of 94.7%, Serum calprotectin levels ≥ 45 µg/ml had a sensitivity of 96% and specificity of 94%, ascitic calprotectin levels ≥ 0.95 µg/ml had a sensitivity of 95% and specificity of 89.2%, serum endocan levels ≥ 2.03 ng/ml had a sensitivity of 90% and specificity of 83.7%, ascitic procalcitonin levels ≥0.33ng/ml had a ARAFAT KASSEM et al. 258sensitivity of 89.9% and specificity of 83.3%, ascitic endocan levels ≥ 0.65 ng/ml had a sensitivity of 88.9% and specificity of 78.5%, and lastly serum procalcitonin levels ≥2.50 ng/ml had a sensitivity of 87.9% and specificity of 76.8% for the diagnosis of SBP in decompensated cirrhotic patients. Conclusion:Ascitic fluid PMNs, serum calprotectin, ascitic calprotectin,serum endocan, ascitic procalcitonin, and serum procalcitonin, could be useful as powerful diagnostic markers to assess the progression of liver disease and early prediction of spontaneous bacterial peritonitis in cirrhotic patients.

Study use of Interferon Gamma-Induced Protein 10 Kda and C-Reactive Protein as Diagnostic Markers for Spontaneous Bacterial Peritonitis

“…When a bacterial strain is isolated in microbiological culture and/or the polymorphonuclear leukocyte count is ≥ 250 in 1 milliliter of ascites fluid (either manually or automatically counted), this is the most sensitive indicator of diagnosis [1]. Nearly all patients with ascites at the time of hospital admission, as well as those who appeared with systemic manifestation of infection as fever, peritoneal infection as generalized dull aching abdominal pain, deterioration of liver condition as hepatic encephalopathy, or rapid deterioration in renal function, are advised to undergo a diagnostic paracentesis [2].…”

Serum Endocan Levels In Patients with Spontaneous Bacterial Peritonitis

“…ng/ml](25) . also, another study found that serum endocan levels were significantly higher in patients with SBP [median (IQ) 3.2 (0.55-5.9)ng/ml] than patients without SBP [median (IQ) 6.2 (5.3-8.75)ng/ml] (26).…”