Neutrophil Gelatinase-associated Lipocalin-2 and Macrophage antigen -1 in Cirrhotic Patients Infected with Carbapenem Resistant Enterobacteriaceae

Abstract

Background: Early detection of bacterial infection in patients with cirrhosis remains a hope for improved prognosis to decrease the morbidity and mortality rate.Objective: To study the diagnostic importance of Neutrophil gelatinase-associated lipocalin-2 and macrophage antigen -1 for early detection of infection in cirrhotic patients and their relationship with carbapenem resistant bacteria. Methodology: 150 patients were divided into group I: cirrhotic patients complicated with infection subdivided into three subgroups; A: fifty-five patients with spontaneous bacterial peritonitis (SBP), Subgroup B: fifteen patients with culture-negative neutrocytic ascites (CNNA) and subgroup C: thirty patients with urinary tract infection. Group II: fifty cirrhotic patients without infections. NGAL-2 estimation was done by ELISA, neutrophil MAC-1 by flowcytometry and Carbapenem resistance genes; OXA-48 and KPC-3 were detected by RFLP-PCR analysis Results: Significant increase of ascitic fluid neutrophils and WBCs count in SBP subgroup. Mean fluorescence intensity of Mac-1 and NGAL-2 concentrations were significantly higher in cirrhotic infected than uninfected patients. The OXA-48 and KPC-3 Carbapenem resistant gram-negative bacteria were prevalent among cirrhotic infected patients. NGAL-2 can detect early infection in cirrhotic patients followed by Mac-1. Conclusion: NGAL-2 and Mac-1 could be used for early detection of bacterial infection in cirrhotic patients with high specificity and sensitivity.