Hepatic Deterioration in Patients with Spontaneous Bacterial Peritonitis, the Role of Tumour Necrosis Factor- Alpha and Interleukin-6
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Background and study aims: Spontaneous bacterial peritonitis (SBP) is an infectious complication observed in patients with cirrhosis and ascites, representing a manifestation of severe derangement of hepatic functions. The aim of this study was to assess the role of tumour necrosis factor- alpha (7'NF-a) and interleukin-6 (IL-6) in hepatic deterioration in cirrhotic patients with SBP . Patients and methods: Twenty eight cirrhotic patients with ascites were divided into two groups: groupl (n = 16) , complicated by spontaneous bacterial peritonitis , nine males and seven females, and group 11 (n = 12) , not complicated by spontaneous bacterial peritonitis used as control, eight males and four females. The mean ages were 56.9 ± 7.4 and 56.2 ± 7.4 years in group land 11 respectively. For all patients complete medical history, clinical examination, abdominal ultrasonography, liver function tests, ascitic fluid analysis, serum levels of both 77VF-a and IL-6 by enzyme-linked immunosorbent assay (ELISA) were done Results: Serum levels of TIVF-a, IL-6, total bilirubin, alanine aminotrarrtsferase (AL7), aspartate aminotransferase (AS7),prothrombin time, and ascitic total and polymorphnuclear cell counts were significantly higher in group 1 compared to group II while albumin content of ascitic fluid was significantly lower in group I compared with group II. However, no significant difference was found between two groups as regard total serum protein, serum albumin and total ascitic protein .In addition, there was a significant positive correlation between serum levels of both TNF-a and IL-6, and ALT, AST and prothrombin time. However, there was a significant negative correlation between serum levels of both 77VF-a and 1L-6, and serum albumin. Furthermore, there was a positive correlation between serum levels of both 77VF-a and IL-6 and serum total bilirubin but no statistically significant difference. Conclusion: Serum levels of both 77VF-a and 1L-6 were higher in cirrhotic patients with SBP than in patients with sterile ascites. The elevation of these parameters were parallel to deterioration of liver functions. Thus, these cytokines could be play a major role in hepatic impairment . further studies needed for clarifring the role of these parameters as a predictor of poor prognosis in cirrhotic patients with SBP.