Study of Serum and Ascitic Fluid Procalcitonin Levels in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis: Diagnostic Value and Relationship to C-Reactive Protein
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Aim of work: The aim of this work is to study the serum and ascitic fluid levels of C-reactive protein (CRP) and procalcitonir (PCT) in cirrhotic patients with and tt.ithout spontaneous bacterial peritonitis (SBP) to assess their predictive value in tht, diagnosis and the severity of the infection. Patients and Methods: Ninety patients with decompensated liver cirrhosis were selected from those admitted to Intern Medicine Department of Benha University Hospitals. Their ages ranged from 47 to 67 years (with a mean age of 55± 9.2). The) were classified into 2 groups: Group!: included 45 patients with decompensated liver cirrhosis and SBP and Group II: include( 45 patients with decompensatcd liver cirrhosis without SBP who served as a control group. The diagnosis of SBP was based or the presence of an ascitic fluid polytnorphonuclear leukocyte count >250 cells/mm" and/or positive aseitie fluid cultures, in tht absence of clinical and laboratory evidence suggesting secondary peritonitis. Results: The mean levels of CRP concentrations were higher both in serum and in ascitic fluid in patients with SBP compare( to those without SBP (88.4 ± 61.3 vs. 19.7 ± 18.4 mg/I and 25.7 ± 24.3 vs. 4.6 + 5.2 mg/I, Pc 0.001, respectively). The meat levels of PCT concentrations in both serum and in ascites were significantly higher in patients with SBP compared to thost without SBP (2.14 ± 0.4 vs. 0.3 ± 0.2 ng/ml and 0.58 ± 0.7 vs. 0.19 ± 0.1 ng/ml, Pc 0.001, respectively). For the diagnosis o• SBP, the PCT in the serum with a cut-off value of 0.76 ng/ml had a sensitivity of 94% and a specificity of 97%, in comparisor to sensitivity/ specificity of serum CRP and PMNs (64/93% and 59/91%, with a cut-off value of 60 mg/I and 8400/mm respectively). interestingly, the ascitic fluid PCT, with a cut-off value of 0.3 ng/ml, had a high sensitivity (92%) and specificit) (87%) in comparison to sensitivity/ specificity of ascitic fluid CRP and PMNs (82/83 and 84/86 with a cut-off value of:: mg/I and 250/mm3, respectively). No correlation was found between PCT and CRP nor between PCT and PMNs in serum no ascitic fluid (P> 0.05, respectively). Multiple regression analysis on the biological data showed that serum PCT was the onl) independent predictor of SHP (P<0.05). The mean PCT and CRP serum levels were significantly more elevated in septic shod (4.2 ± 0.3 rig/nil and 99.1 ± 13 mg/)) than in sepsis (1.4 ± 0.1 ng/ml and 84.2 ± 9 mg/1) and severe sepsis (2.5 + 0.2 ng/ml am 91.2 ±1 I mg/I) (Pc 0.05 and Pc 0.001, respectively). Conclusion: It is concluded from this study that serum PCT level may have a predictive value for the diagnosis of SBP ii cirrhotic patients. Also, our data showed that PCT may be used not only as a marker of infection, but, more importantly, as good marker for the severity of infection. Recommendation: Further studies are recommended on a bigger number of patients with SBP to obtain more convincitm results. Also further studies are needed to illustrate the role of PCT in the detection of infection especially in immuno-suppresset patients.