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Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 1871-5230
ISSN (Online): 1875-614X

Research Article

The Role of Serum Procalcitonin Level as an Early Marker of Ascitic Fluid Infection in Post Hepatitic Cirrhotic Patients

Author(s): Mohamed Zakaria Abu Rahma, Zainab Gaber Mahran, Engy Adel Shafik , Dina Ahmed Mohareb, Nessren M. Abd El-Rady, Mohamed A. Mustafa , Mahmoud Khalil, Yousry Esam-Eldin Abo-Amer and Sherief Abd-Elsalam*

Volume 20, Issue 1, 2021

Published on: 03 March, 2020

Page: [61 - 67] Pages: 7

DOI: 10.2174/1871523019666200303104932

Price: $65

Abstract

Aims & Background: The early diagnosis of spontaneous bacterial peritonitis (SBP) has been considered important in the overall patient’s survival. Ascitic fluid culture examination performance, in the emergency setting, is time-consuming and not always available, so there is a need for easy to apply, rapid and reliable markers for diagnosis of patients with ascites. The present prospective study aimed to determine the early diagnostic value of serum procalcitonin (PCT) levels in decompensated cirrhotic patients (DCPs) with SBP.

Methods: 47 HCV cirrhotic patients with ascites were enrolled for this prospective study. The severity of cirrhosis was classified based on the Child–Pugh criteria. All patients were subjected to paracentesis and ascitic fluid (AF) culture. Serum PCT levels were measured using enzyme-linked fluorescence analysis (ELFA).

Results: The diagnostic value of serum PCT levels and WBC/PLT ratios for detecting infections were serum PCT levels (3.63 ± 3.47 ng/mL) in DCPs with infections which were significantly higher than in DCPs without infections (0.505 ± 0.230 ng/mL); p < 0.05. The cut-off value for serum PCT levels was 0.7 ng/mL for the diagnosis of infections in DCPs, for which the sensitivity and specificity were 93.1% and 73.2%, respectively. The AUC was 0.91 (95% CI: 0.83-0.99).

Conclusion: Serum procalcitonin seems to provide satisfactory diagnostic biomarkers in SBP.

Keywords: Cirrhosis, ascites, SBP, procalcitonin, biomarker, diagnosis.

Graphical Abstract
[1]
European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J. Hepatol., 2010, 53(3), 397-417.
[http://dx.doi.org/10.1016/j.jhep.2010.05.004] [PMID: 20633946]
[2]
Hoefs, J.C.; Runyon, B.A. Spontaneous bacterial peritonitis. Dis. Mon., 1985, 31(9), 1-48.
[http://dx.doi.org/10.1016/0011-5029(85)90002-1] [PMID: 3899555]
[3]
Nousbaum, J.B.; Cadranel, J.F.; Nahon, P.; Khac, E.N.; Moreau, R.; Thévenot, T.; Silvain, C.; Bureau, C.; Nouel, O.; Pilette, C.; Paupard, T.; Vanbiervliet, G.; Oberti, F.; Davion, T.; Jouannaud, V.; Roche, B.; Bernard, P.H.; Beaulieu, S.; Danne, O.; Thabut, D.; Chagneau-Derrode, C.; de Lédinghen, V.; Mathurin, P.; Pauwels, A.; Bronowicki, J.P.; Habersetzer, F.; Abergel, A.; Audigier, J.C.; Sapey, T.; Grangé, J.D.; Tran, A. Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis. Hepatology, 2007, 45(5), 1275-1281.
[http://dx.doi.org/10.1002/hep.21588] [PMID: 17464969]
[4]
Runyon, B.A.; Hoefs, J.C. Culture-negative neutrocytic ascites: A variant of spontaneous bacterial peritonitis. Hepatology, 1984, 4(6), 1209-1211.
[http://dx.doi.org/10.1002/hep.1840040619] [PMID: 6500513]
[5]
Runyon, B.A. Management of adult patients with ascites caused by cirrhosis. Hepatology, 1998, 27(1), 264-272.
[http://dx.doi.org/10.1002/hep.510270139] [PMID: 9425946]
[6]
Wiest, R.; Krag, A.; Gerbes, A. Spontaneous bacterial peritonitis: Recent guidelines and beyond. Gut, 2012, 61(2), 297-310.
[http://dx.doi.org/10.1136/gutjnl-2011-300779] [PMID: 22147550]
[7]
Mostafa, M.S.; El-Seidi, E.A.; Kassem, A.M.; Shemis, M.A.; Saber, M.; Michael, M.N. Detection of ascitic fluid infections in patients with liver cirrhosis and ascites. Arab J. Gastroenterol., 2011, 12(1), 20-24.
[http://dx.doi.org/10.1016/j.ajg.2011.01.004] [PMID: 21429450]
[8]
Fernandez, J; Navasa, M Planas, R 2007 Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology, 2007, 133(3), 818-824.
[http://dx.doi.org/10.1053/j.gastro.2007.06.065]
[9]
Albillos, A.; Cuervas-Mons, V.; Millán, I.; Cantón, T.; Montes, J.; Barrios, C.; Garrido, A.; Escartín, P. Ascitic fluid polymorphonuclear cell count and serum to ascites albumin gradient in the diagnosis of bacterial peritonitis. Gastroenterology, 1990, 98(1), 134-140.
[http://dx.doi.org/10.1016/0016-5085(90)91301-L] [PMID: 2293572]
[10]
Gendrel, D.; Bohuon, C. Procalcitonin as a marker of bacterial infection. Pediatr. Infect. Dis. J., 2000, 19(8), 679-687.
[http://dx.doi.org/10.1097/00006454-200008000-00001] [PMID: 10959733]
[11]
Badawi, R.; Asghar, M.N.; Abd-Elsalam, S.; Elshweikh, S.A.; Haydara, T.; Alnabawy, S.M.; Elkadeem, M.; ElKhalawany, W.; Soliman, S.; Elkhouly, R.; Soliman, S.; Watany, M.; Khalif, M.; Elfert, A. Amyloid A in serum and ascitic fluid as a novel diagnostic marker of spontaneous bacterial peritonitis. Antiinflamm. Antiallergy Agents Med. Chem., 2019, 2019(Apr), 1.
[http://dx.doi.org/10.2174/1871523018666190401154447] [PMID: 30931865]
[12]
Sharaf-Eldin, M.; Bediwy, A.S.; Kobtan, A.; Abd-Elsalam, S.; El-Kalla, F.; Mansour, L.; Elkhalawany, W.; Elhendawy, M.; Soliman, S. Pigtail Catheter: A less invasive option for pleural drainage in egyptian patients with recurrent hepatic hydrothorax. Gastroenterol. Res. Pract., 2016, 2016, 4013052.
[http://dx.doi.org/10.1155/2016/4013052] [PMID: 27340399]
[13]
Saleh, A.M.; Hassan, E.A.; Gomaa, A.A.; El Baz, T.M.; El-Abgeegy, M.; Seleem, M.I.; Abo-Amer, Y.E.; Elsergany, H.F.; Mahmoud, E.I.E.; Abd-Elsalam, S. Impact of pre-transplant infection management on the outcome of living-donor liver transplantation in Egypt. Infect. Drug Resist., 2019, 12, 2277-2282.
[http://dx.doi.org/10.2147/IDR.S208954] [PMID: 31413604]
[14]
Helal, E.M.; Sharaf-Eldin, M.; Abou El Azm, A.R.; Badr Eldin, N.M.; Dawoud, M.M.; Abd-Elsalam, S.; Ziada, D.H. Hemodynamic changes of hepatic & renal vessels in systemic bacterial infection with fever in HCV related cirrhosis. Infect. Disord. Drug Targets, 2019, 2019, 5.
[http://dx.doi.org/10.2174/1871526519666190506102703] [PMID: 31057113]
[15]
Viallon, A.; Zeni, F.; Pouzet, V.; Lambert, C.; Quenet, S.; Aubert, G.; Guyomarch, S.; Tardy, B.; Bertrand, J.C. Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines. Intensive Care Med., 2000, 26(8), 1082-1088.
[http://dx.doi.org/10.1007/s001340051321] [PMID: 11030164]
[16]
Hamed, M.; Hakim, H.; El-Masshad, N. Serum procalcitonin and C-reactive protein in prediction of spontaneous bacterial peritonitis. Gastroenterol. Hepatol. J., 2017, 1(1), 20-23.
[17]
Cekin, Y.; Cekin, A.H.; Duman, A.; Yilmaz, U.; Yesil, B.; Yolcular, B.O. The role of serum procalcitonin levels in predicting ascitic fluid infection in hospitalized cirrhotic and non-cirrhotic patients. Int. J. Med. Sci., 2013, 10(10), 1367-1374.
[http://dx.doi.org/10.7150/ijms.6014] [PMID: 23983598]
[18]
Elshayeb, E.I.; Badra, M.H.; Abdu Elgayedb, E.M. Serum and ascitic procalcitonin as a marker for early diagnosis of spontaneous bacterial peritonitis. Egypt. J. Intern. Med., 2019, 31(2), 208-213.
[http://dx.doi.org/10.4103/ejim.ejim_74_18]
[19]
Burri, E.; Schulte, F.; Muser, J.; Meier, R.; Beglinger, C. Measurement of calprotectin in ascitic fluid to identify elevated polymorphonuclear cell count. World J. Gastroenterol., 2013, 19(13), 2028-2036.
[http://dx.doi.org/10.3748/wjg.v19.i13.2028] [PMID: 23599621]
[20]
Gad, M.A. Role of calprotectin in diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Afro-Egypt J. Infect. Endem. Dis, 2015, 5(4), 226-234.
[http://dx.doi.org/10.21608/aeji.2015.17843]
[21]
Rito Norbe, S.; Pina Cabral, J.E.; Sofia, C. Value of reagent strips and calprotectin role in the rapid diagnosis of spontaneous bacterial peritonitis. Hepatogastroenterology, 2008, 55(84), 1020-1023.
[PMID: 18705321]
[22]
Lesińska, M.; Hartleb, M.; Gutkowski, K.; Nowakowska-Duława, E. Procalcitonin and macrophage inflammatory protein-1 beta (MIP-1β) in serum and peritoneal fluid of patients with decompensated cirrhosis and spontaneous bacterial peritonitis. Adv. Med. Sci., 2014, 59(1), 52-56.
[http://dx.doi.org/10.1016/j.advms.2013.07.006] [PMID: 24797975]
[23]
Yuan, L.Y.; Ke, Z.Q.; Wang, M.; Li, Y. Procalcitonin and C-reactive protein in the diagnosis and prediction of spontaneous bacterial peritonitis associated with chronic severe hepatitis B. Ann. Lab. Med., 2013, 33(6), 449-454.
[http://dx.doi.org/10.3343/alm.2013.33.6.449] [PMID: 24205495]
[24]
Wu, H.; Chen, L.; Sun, Y.; Meng, C.; Hou, W. The role of serum procalcitonin and C-reactive protein levels in predicting spontaneous bacterial peritonitis in patients with advanced liver cirrhosis. Pak. J. Med. Sci., 2016, 32(6), 1484-1488.
[http://dx.doi.org/10.12669/pjms.326.10995] [PMID: 28083050]

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