Role of serum complement, immunoglobulins, and cell-mediated immune system in the pathogenesis of spontaneous bacterial peritonitis (SBP)

Abstract

Spontaneous bacterial peritonitis (SBP) is a common complication of advanced liver disease, which has a reported prevalence of between 4 and 27%. Frequent bacteremias due to inadequate host defense mechanisms, particularly the reticuloendothelial system (RES), with seeding of an ascitic fluid that lacks a normal opsonic activity, is believed to be the principal cause of SBP. Little data exist as to the role of serum levels of complement and immunoglobulins as well as the cell-mediated immune system in the pathogenesis of SBP. The aim of this study was to determine the serum levels of the third and fourth components of complement (C3, C4), total hemolytic complement activity (CH100), and properdin factor B (PFB) and immunoglobulins G, A, and M and various T-cell parameters in individuals admitted to hospital with ascites and advanced liver disease and to determine whether one or more of these factors could be used to predict the development of SBP in patients with advanced liver disease. Fourteen consecutive patients (nine male and five female; age 47.5 +/- 3.1 years, mean +/- SEM) with end-stage liver disease and ascites, who were evaluated for possible liver transplant at the University of Pittsburgh and who developed SBP, comprised the study group. The diagnosis of SBP was determined by positive ascitic fluid culture (three patients) and/or ascitic fluid neutrophil count of greater than 250 cells/mm3 (all patients). The control group consisted of 14 patients, matched for type of liver disease, age, and sex, who did not develop SBP.(ABSTRACT TRUNCATED AT 250 WORDS)

Systematic review and meta-analysis of the possible association between pharmacological gastric acid suppression and spontaneous bacterial peritonitis

“…Although the precise mechanism of development of SBP in these patients is not well understood, evidence suggests that increased intestinal permeability, changes in intestinal microbiota, bacterial translocation, and delayed gut motility may be involved in the pathogenesis [14,15]. Animal studies have suggested that low levels of complement proteins and impaired phagocytic function may also contribute toward its development [16,17].…”

Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I

“…Therefore, the administration of agents that decrease bile acid levels, bacterial translocation, or secondary consequences of endotoxin circulation and inflammation could be considered therapeutic options. 2,108,138,[161][162][163][164][165][166][167][168][169] For instance, ursediol (ursodeoxycholic acid) has been shown in some studies to decrease bile acid toxicity and endotoxin levels, as well as soluble ICAM-1 and TNF-␣ levels, and even decrease intestinal production of nitric oxide. 146,152,[170][171][172][173][174][175] In addition, MARS treatments (albumin dialysis with hemofiltration) have been shown to decrease TNF-␣ and IL-6 levels and improve survival in type 1 HRS.…”

Peritonite bacteriana espontânea na cirrose hepática: prevalência, fatores preditivos e prognóstico

“…Isto se justifica, pois estes pacientes têm uma pior função hepática com comprometimento da capacidade de síntese destas proteínas. É amplamente sabido que pacientes cirróticos com doença avançada têm menores dosagens de proteínas séricas 4,5,11,[40][41][42] e que isto se correlaciona com o prognóstico.…”

“…Várias anormalidades na resposta imune têm sido descritas no paciente com cirrose, incluindo níveis de complemento sérico e do LA deficientes 37,[41][42][43][44][45] . Os nossos valores de C3 e C4 séricos foram similares aos de outros estudos em cirróticos 42,46 .…”