Introduction: SBP is a common and frequently fatal bacterial infection of the ascitic fluid (AF) that occurs in cirrhotic patients. It is characterized by poor outcome and high mortality, ranging from 10 to 30 % at the first in-hospital episode, up to 80-90% in untreated patients. Because of the bad prognosis of untreated SBP, the diagnosis of disease and the identification of the underlying cause should be performed as soon as possible. Objective: The aim of this study was to evaluate the usefulness of ascitic fluid lactoferrin and MIP-1β levels, serum MIP-1β level and leukocyte esterase bed side test as diagnostic markers for rapid diagnosis of SBP in cirrhotic ascitic patients. Patients & Methods: Sixty cirrhotic ascitic patients (20 patients without SBP and 40 patients with SBP while the diagnosis of SBP was based on detection of a PMNs count ≥ 250 cells/mm3 of ascitic fluid ) were subjected to laboratory investigations which included ; CBC, liver profile, renal function tests, serum sodium & potassium, serum glucose, abdominal ultrasonography and assessment of liver disease severity by Child- Pugh score. Diagnostic abdominal paracentesis was done for all patients and ascitic fluid was subjected to total and differential leucocytic count, leucocyte esterase test, detection of ascitic fluid MIP-1β levels, and lactoferrin levels and also serum MIP-1β level to assess their usefulness for rapid diagnosis of SBP in studied patients. Results: AF and serum MIP1β levels and AF lactoferrin level were higher in SBP group than non SBP group with high statistical significance. Ascitic fluid MIP-1β sensitivity at cut-off value ≥ 29.8 was 92.5%, specificity was 85% , PPV was 92.5% , NPV was 85% with accuracy of 90% , while serum MIP-1β sensitivity and specificity at cut-off value ≥ 6.6 were 80% for each , PPV was 85.7% , NPV was 72.7% and the accuracy was 80% for SBP diagnosis. On the other hand , AF lactoferrin at cut-off value ≥ 1741.5 had sensitivity of 70 %, specificity of 65 %, PPV of 80 % and NPV of 52 % with accuracy of 68.3%. Combined use of MIP1β and +Lactoferrin scored higher values with sensitivity of 97.5%, specificity of 85%, PPV of 92.8 %, NPV of 94.4% and the accuracy was 93.3% for SBP diagnosis. The of Leucocyte esterase test at cut-off value ≥ +1; had sensitivity of 87.5% and specificity of 100%, positive predictive value 100%, negative predictive value 80% and accuracy of 91.7% for SBP diagnosis. Conclusion: our study demonstrated high sensitivity, specificity and diagnostic accuracy for leucocyte esterase reagents strips in SBP diagnosis. Moreover, it is cheap, rapid, easy applicable bedside test so it is recommended to be used as a screening test for SBP especially in centers with limited resources. Measuring ascitic fluid and serum levels of MIP-1β by ELISA is an easy, rapid and reproducible method and could act as surrogate markers for early diagnosis of SBP. Lactoferrin level in ascitic fluid yield low validity values, however, combined measurement of both ascitic fluid MIP -1β and lactoferrin levels results in higher values than that of each one alone. |
