Clinical significance of serum and ascites procalcitonin levels in liver cirrhotic patients with spontaneous bacterial peritonitis
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Objective To study serum and ascites levels of procalcitonin(PCT) in liver cirrhotic patients with spontaneous bacterial peritonitis and their clinical significance.Methods The 71 cirrhotic patients with ascites were selected into this study among whom there were 49 patients with spontaneous bacterial peritonitis(SBP) and 22 without SBP.Serum and ascites levels of PCT were detected and compared with those of normal controls.Results Serum levels of PCT in patients with SBPand without SBP patients were significantly higher than those in normal controls(P0.01); Serum levels of PCT in patients with SBP were significantly higher than those in patients without SBP(P0.01); ascites levels of PCT in patients with SBP were significantly higher than those in patient without SBP (P0.01).Conclusion The detection of serum and ascites levels of PCT has an important value in early diagnosis and judgement of prognosis of SBP in liver cirrhosis.Keywords:
Spontaneous bacterial peritonitis
Procalcitonin
Clinical Significance
Clinical judgement
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Objectives To evaluate the diagnostic value of serum and ascitic fluid monocyte chemotactic protein-1 (MCP-1) level in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP). Background SBP is one of the potential life-threatening complications in ascitic cirrhotic patients, with a mortality rate ranging between 30 and 50%. Patients and methods This study was conducted on 40 patients with cirrhotic ascites with and without SBP admitted to Internal Medicine Department, Menoufia University Hospital, and El Sahel Teaching Hospital from October 2017 to October 2018. All patients included in this study were divided into two groups as follows: group I included 10 ascitic patients without SBP, and group II included 30 ascitic patients with SBP. Results Mean level of MCP-1 was significantly higher in SBP group than non-SBP group. For MCP-1, the cutoff point that gives an area of 91% was 122.5 ng/ml, with sensitivity of 86% and of specificity 95%. For serum MCP-1, the cutoff point that gives an area of 91% was 100.5 ng/ml, with of sensitivity 85% and specificity of 94%. For polymorphonuclear cell count, the cutoff point that gives an area of 78% was 62.5 cell/cm3, with a sensitivity of 100% and specificity of 41%. Conclusion MCP-1 is a good diagnostic marker for SBP with its high sensitivity (86.7%) and specificity (95.4%) with high reliability (91%) in patients with SBP. Moreover, MCP-1 is a good prognostic marker owing to its positive relation with the severity of liver disease, which is indicated by high model for end-stage liver disease scores.
Spontaneous bacterial peritonitis
Ascitic fluid
Monocyte
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Background: Liver cirrhosis is associated with frequent bacterial infections that increase mortality.Spontaneous bacterial peritonitis (SBP) is an important cause of mortality and morbidity in such patients with ascites.A polymorphonuclear (PMN) cell count >250/μl in the ascitic fluid is the current gold standard for diagnosing SBP which is considered a subjective test.Early diagnosis of SBP although vital is difficult in these patients.Interleukin 6 is pro-inflammatory marker that increases earlier in bacterial infection than other inflammatory markers.This is crucial in cirrhotic patients to initiate treatment accordingly.Results: Ascitic IL6 mean value was 2171.5(62.2-5000) and 342.5(146 -2567) pg/ml in groups I and II respectively which was significantly higher in group I than among group II patients (P<0.001).Furthermore, the mean s. procalcitonin was 0.8(0.4-1.1) and 0.4(0.04-0.7)ng/ml among groups In and II respectively and it was significantly higher among the patients with SBP (P<0.001).Diagnosis of SBP among patients with liver cirrhosis could be suggested when ascitic IL6 and serum procalcitonin are assessed at a cut-off values of >780 pg/ml and >0.4ng/ml respectively. Conclusion:Ascitic IL6 and serum procalcitonin can be used as a valuable surrogate serum marker for early diagnosis of SBP in cirrhotic patients.
Procalcitonin
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Objective: To discuss the clinical value of ascites procalcitonin(PCT) in the diagnosis of decompensated cirrhosis combined with spontaneous bacterial peritonitis(SBP), and determine the reference level of ascites PCT. Methods: 42 patients with liver cirrhosis combined with ascites were enrolled in this study and divided into two groups. In group 1, 22 patients with SBP were enrolled.20 without SBP were enrolled in group 2, and ascite sample were collected at admission, 24 hrs, and 48 hrs after admission. Serum and ascites PCT were measurated by immunochromatographic assay simultaneously, then comparative analysis the level of their changes.Results: The serum and ascite levels of PCT in patients(n=22) with SBP were significantly higher than those without SBP(n = 20)(P0.01); but there is no statistical significance between the ascites and serum level of PCT in patients with SBP(P 0.05). A more sensitive diagnostic role of ascites PCT levels was found compared with serum PCT and ascites cell counts. The AUCs of ROC curve were: at admission: ascites PCT 0.986, serum PCT 0.942 and ascites cell counts 0.868; 24 h after admission: ascites PCT 0.998 and serum PCT0.986; 48 h after admission: ascites PCT 0.986 and serum PCT 0.990. Conclusion: Serum ascites PCT could be used in the diagnosis in liver cirrhosis with SBP, and may be more sensitive than serum PCT and ascites cell counts. The SBP could be diagnosed, if the ascites PCT levels was higher than 0.565 ng/m L(on admission), 0.545 ng/m L(24 h after admission) and 0.410 ng/m L(48 h after admission).
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Serum and ascitic procalcitonin as a marker for early diagnosis of spontaneous bacterial peritonitis
of the work Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with decompensated cirrhosis. SBP is an inflammation of the peritoneum by micro-organisms such as gram-negative bacilli. Early diagnosis of SBP is essential which may be a challenge for clinicians owing to lack of symptoms in early stage of SBP. The aim of this study is to evaluate procalcitonin (PCT) level in the serum and ascitic fluid of patients with cirrhosis for early diagnosis of SBP. This study was carried out on 45 patients with decompensated liver cirrhosis. They were classified into two groups: group 1 included 15 patients free of SBP and group 2 with SBP based on ascetic polymprphnuclear leucocytes (PNLs) more than 250/ 3 mm and ascitic fluid culture. Evaluation of C-reactive protein, ascetic fluid polymorphs count, and serum and ascetic PCT levels was done for all patients. No significant difference between SBP group and non-SBP group regarding ascetic PCT level, with P value more than 0.05. Serum PCT in patients with SBP shows high statistically significant difference, with P value less than 0.005, in comparison with patients without SBP. Serum PCT is a good predictor marker for early diagnosis of SBP in patients with decompensated cirrhosis.
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Objective To observe the level of procalcitonin(PCT)of liver cirrhosis patients with spontaneous bacterial peritonitis(SBP) and its changes in treatment so as to study the value of PCT in early diagnosis and prognostic judgement for the patients.Methods 80 liver cirrhosis patients with ascites in our department were divided into two groups,SBP group(n=30) and non-SBP group(n=50),according to whether they had spontaneous bacterial peritonitis.The temperature,abdominal signs,ascites,routine blood test and PCT of the groups were observed dynamically so as to study the relationship between the changes of PCT and SBP.Results The PCT level of SBP group was obviously higher than that of non-SBP group.PCT level was positively related to the prognosis of SBP(P0.05).Conclusion The PCT level has diagnostic value for patients with liver cirrhosis and ascites.The PCT level is positively correlated with the severity of the disease.Early PCT detection and early use of antibiotics can improve the prognosis of the patients.
Spontaneous bacterial peritonitis
Procalcitonin
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Objective To explore the clinical significances of the combination detection of serum Prealbumin(PA), C-reactive protein(CRP) and Procalcitonin(PCT) in the liver cirrhosis paitents complicated with spontaneous bacterial peritonitis (SBP). Method The levels of PA, CRP and PCT were detected in 30 liver cirrhosis paitents complicated with SBP and 30 liver cirrhosis without SBP paitents and compared each other and with normal group. Result The level of PA in liver cirrhosis paitents without SBP complicated with SBP and liver cirrhosis paitents without SBP were significantly lower than that in control group (P0.01). The levels of CRP and PCT in liver cirrhosis paitents complicated with SBP were markedly higher than those in control group (P0.01); while, there was no significantly difference between liver cirrhosis group and normal group. The levels of CRP and PCT in 20 SBP paitents after valid treatment were significantly different form those before treatment (P0.01). Conclusion The combination detection of serum levels of PCT and CRP has an important value in early diagnosis, judgment of prognosis and curative effect of liver cirrhosis complicated with SBP.
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To investigate the diagnostic value of plasma procalcitonin (PCT) and endotoxin for spontaneous bacterial peritonitis ( SBP) in liver cirrhosis, studying the relationship between them and pathogen typing, clinical prognosis. The plasma levels of PCT and endotoxin in 89 patients with cirrhotic ascites( with SBP 38 and without 51) were measured by gold immunochrornatographic assay and fluorometric method, respectively. Plasma levels of PCT and endotoxin were significantly raised above normal value in all patients. The positive rate of PCT ( 10ng/ml) and levels of endotoxin were significantly higher in SBP group than those in without SBP group (P 0.001). Plasma levels of endotoxin were remearkably higher with G~ bacterial infection than that with G+ bacterial infection ( P 0.01) ,and there was no significant difference on the positive rate of PCT( 100% vs 88.9% , P 0.05) . Dynastic observe the variation of plasma PCT in the first three days was superior to endotoxin in the predictability to different outcome and the guidance of clinical treatment. Dynastic detection of PCT and endotoxin has important value in early diagnosis, pathogen initiative typing, evaluation therapy and judgement prognosis of SBP in liver cirrhosis.
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Objective To explore the sensitivity and specificity of combination detection of Procalcitonin(PCT) and C-reactive protein(CRP) in the liver cirrhosis patients complicated with spontaneous bacteria1 peritonitis(SBP),and provide the evidence for clinical diagnosis.Methods The levels of PCT and CRP were detected in 45 liver cirrhosis patients complicated with SBP,45 liver cirrhosis patients without SBP and 45 general hepititis patients.Results Compared with general hepatitis patients,the levels of PCT and CRP in liver cirrhosis patients complicated with SBP were markedly higher(t=5.20,P0.05;t=7.94,P0.05);while,there were no significantly differences between liver cirrhosis group without SBP and general hepatitis group(t=1.17,P0.05;t=1.92,P0.05).The sensitivity and specificity of PCT were better than CRP.Conclusion It is more accurate to detect PCT and CRP together in early diagnosis of liver cirrhosis complicated with SBP.
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To determine the role of serum procalcitonin (PCT) and C-reactive protein (CRP) in predicting spontaneous bacterial peritonitis (SBP) in patients with advanced liver cirrhosis.A total of 88 patients with advanced liver cirrhosis were enrolled for this study, which included 40 cases with SBP and 48 cases with CNNA. Bacterial cultures, ascitic fluid (AF) leukocyte, C-reactive protein (CRP) and serum PCT measurements were carried out prior to the use of antibiotics. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels.Serum PCT levels in advanced liver cirrhotic patients with SBP were significantly higher than those with CNNA. We used PCT 0.78 ng/mL as optimal cutoff value to diagnose SBP, for which the sensitivity and specificity was 77.5% and 60.4%. The area under the curve (AUC) was 0.706 (95% confidence interval: 0.576-0.798). The PCT level was significantly correlated with the AF WBC count (rs=0.404, P<0.01). However, there was no significant difference between SBP and CNNA patients in serum CRP levels.According to our findings, serum PCT levels seem to provide an early diagnostic accuracy in advanced liver cirrhotic patients with SBP.
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Spontaneous infection of ascites is a severe complication of ascites and must be actively searched for. Many studies have been carried out on inflammatory markers and their levels in serum and ascitic fluid such as complement 3 (C3), complement 4 (C4), high-sensitive C-reactive protein (CRP), and procalcitonin, and have identified their role in the diagnosis of spontaneous bacterial peritonitis (SBP). The aim of our study was to measure and compare the serum and ascitic fluid levels of procalcitonin, high-sensitive CRP, C3, and C4 in patients with SBP and patients without SBP. This case–control study was carried out on 10 patients with cirrhotic ascites who were admitted with SBP and 20 patients with cirrhotic ascites with no existing evidence of SBP. Serum and ascitic fluid levels of C3, C4, high-sensitive CRP, and procalcitonin were determined using the enzyme-linked immunosorbent assay method. The mean ± SD of the serum levels of C3, C4, high-sensitive CRP, and procalcitonin were 3.38 ± 2.12, 0.36 ± 0.25, 18.76 ± 6.37, and 136.79 ± 58.14, respectively, in group I, whereas their levels in group II were 2.04 ± 1.98, 0.36 ± 0.29, 16.80 ± 5.97, and 147.78 ± 58.65, respectively. The mean ± SD of their ascitic fluid levels were 0.21 ± 0.14, 1.84 ± 1.69, 1.96 ± 1.15, and 162.43 ± 82.51, whereas their levels in group II were 0.46 ± 1.01, 2.07 ± 1.93, 2.98 ± 5.90, and 180.51 ± 93.70, respectively. Surprisingly, all these results were statistically insignificant. However, an ascetic fluid polymorph nuclear leukocyte count higher than 200/mm3 has sensitivity, specificity, positive predictive value, and negative predictive value of 100% in the diagnosis of SBP. An ascitic polymorph nuclear leukocyte count higher than 200/ml was the accurate marker for the diagnosis of SBP.
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