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Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry


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

Research Article

Amyloid A in Serum and Ascitic Fluid as a Novel Diagnostic Marker of Spontaneous Bacterial Peritonitis

Author(s): Rehab Badawi, Muhammad N. Asghar, Sherief Abd-Elsalam*, Samah A. Elshweikh, Tamer Haydara, Sherein M. Alnabawy, Mahmoud Elkadeem, Walaa ElKhalawany, Samah Soliman, Reham Elkhouly, Shimaa Soliman, Mona Watany, Mai Khalif and Asem Elfert

Volume 19, Issue 2, 2020

Page: [140 - 148] Pages: 9

DOI: 10.2174/1871523018666190401154447


Background: Diagnosis of Spontaneous Bacterial Peritonitis (SBP) depends mainly on ascetic fluid culture which may be negative in spite of the clinical suggestion of SBP and high ascetic fluid neutrophilic count.

Aims: This study aimed to evaluate the biological importance of amyloid A biomarker in both serum and ascetic fluid to diagnose SBP as early as possible and to compare it to other markers (C-reactive protein (CRP), and the neutrophil-to-lymphocyte ratio (NLR)).

Methods: This study included 37 patients with hepatic ascites; twenty-two of them had SBP, and 15 patients did not have SBP. Serum and ascetic fluid amyloid A, ascetic fluid neutrophil, C-reactive protein, and neutrophil-to-lymphocyte ratio were measured in all subjects before the start of antimicrobial chemotherapy to the infected ones.

Results: Both the serum and ascetic fluid amyloid and also, CRP were significantly higher in patients infected with ascetic fluid than others. The cut-off point of serum amyloid A for early detection of SBP was 9.25ug/ml with the high sensitivity and specificity. For ascetic amyloid A, the sensitivity and specificity were 90.09% and 60% at cut-off point 2.85ug/ml, respectively.

Conclusion: Amyloid A in serum and ascitic fluid can be considered as a good biomarker for early diagnosis of SBP.

Keywords: Ascitic fluid, bacterial infections, C-Reactive Protein (CRP), diagnostic marker, Serum Amyloid A (SAA), Spontaneous Bacterial Peritonitis (SBP).

Graphical Abstract
Elfert, A.; Abo Ali, L.; Soliman, S.; Ibrahim, S.; Abd-Elsalam, S. Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis. Eur. J. Gastroenterol. Hepatol., 2016, 28(12), 1450-1454.
[] [PMID: 27512927]
Jalan, R.; Fernandez, J.; Wiest, R.; Schnabl, B.; Moreau, R.; Angeli, P.; Stadlbauer, V.; Gustot, T.; Bernardi, M.; Canton, R.; Albillos, A.; Lammert, F.; Wilmer, A.; Mookerjee, R.; Vila, J.; Garcia-Martinez, R.; Wendon, J.; Such, J.; Cordoba, J.; Sanyal, A.; Garcia-Tsao, G.; Arroyo, V.; Burroughs, A.; Ginès, P. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J. Hepatol., 2014, 60(6), 1310-1324.
[] [PMID: 24530646]
Kerr, D.N.S.; Pearson, D.T.; Read, A.E. Infection of ascitic fluid in patients with hepatic cirrhosis. Gut, 1963, 4, 394-398.
[] [PMID: 14084751]
Conn, H.O. Spontaneous peritonitis and bacteremia in Laennec’s cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome. Ann. Intern. Med., 1964, 60, 568-580.
[] [PMID: 14138877]
Shalimar, ; Acharya, S.K. Difficult to treat spontaneous bacterial peritonitis. Trop. Gastroenterol., 2013, 34(1), 7-13.
[] [PMID: 23923368]
Runyon, B.A. AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4), 1651-1653.
[] [PMID: 23463403]
Cai, Z.H.; Fan, C.L.; Zheng, J.F.; Zhang, X.; Zhao, W.M.; Li, B.; Li, L.; Dong, P.L.; Ding, H.G. Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis. BMC Infect. Dis., 2015, 15, 55.
[] [PMID: 25887691]
Avanzas, P.; Quiles, J.; López de Sá, E.; Sánchez, A.; Rubio, R.; García, E.; López-Sendón, J.L. Neutrophil count and infarct size in patients with acute myocardial infarction. Int. J. Cardiol., 2004, 97(1), 155-156.
[] [PMID: 15336829]
Gabay, C.; Kushner, I. Acute-phase proteins and other systemic responses to inflammation. N. Engl. J. Med., 1999, 340(6), 448-454.
[] [PMID: 9971870]
Okino, A.M.; Bürger, C.; Cardoso, J.R.; Lavado, E.L.; Lotufo, P.A.; Campa, A. The acute-phase proteins serum amyloid A and C reactive protein in transudates and exudates. Mediators Inflamm., 2006, 2006(1), 47297.
[] [PMID: 16864904]
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.
[] [PMID: 20633946]
Soriano, G.; Esparcia, O.; Montemayor, M.; Guarner-Argente, C.; Pericas, R.; Torras, X.; Calvo, N.; Román, E.; Navarro, F.; Guarner, C.; Coll, P. Bacterial DNA in the diagnosis of spontaneous bacterial peritonitis. Aliment. Pharmacol. Ther., 2011, 33(2), 275-284.
[] [PMID: 21083594]
Parsi, M.A.; Saadeh, S.N.; Zein, N.N.; Davis, G.L.; Lopez, R.; Boone, J.; Lepe, M.R.; Guo, L.; Ashfaq, M.; Klintmalm, G.; McCullough, A.J. Ascitic fluid lactoferrin for diagnosis of spontaneous bacterial peritonitis. Gastroenterology, 2008, 135(3), 803-807.
[] [PMID: 18590731]
Fock, R.A.; Blatt, S.L.; Beutler, B.; Pereira, J.; Tsujita, M.; de Barros, F.E.; Borelli, P. Study of lymphocyte subpopulations in bone marrow in a model of protein-energy malnutrition. Nutrition, 2010, 26(10), 1021-1028.
[] [PMID: 20036516]
Kwon, J.H.; Jang, J.W.; Kim, Y.W.; Lee, S.W.; Nam, S.W.; Jaegal, D.; Lee, S.; Bae, S.H. The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis. BMC Gastroenterol., 2015, 15, 146.
[] [PMID: 26498833]
Jimenez, M.F.; Watson, R.W.; Parodo, J.; Evans, D.; Foster, D.; Steinberg, M.; Rotstein, O.D.; Marshall, J.C. Dysregulated expression of neutrophil apoptosis in the systemic inflammatory response syndrome. Arch. Surg., 1997, 132(12), 1263-1269.
[] [PMID: 9403528]
Wesche, D.E.; Lomas-Neira, J.L.; Perl, M.; Chung, C.S.; Ayala, A. Leukocyte apoptosis and its significance in sepsis and shock. J. Leukoc. Biol., 2005, 78(2), 325-337.
[] [PMID: 15817707]
Tritto, G.; Bechlis, Z.; Stadlbauer, V.; Davies, N.; Francés, R.; Shah, N.; Mookerjee, R.P.; Such, J.; Jalan, R. Evidence of neutrophil functional defect despite inflammation in stable cirrhosis. J. Hepatol., 2011, 55(3), 574-581.
[] [PMID: 21236309]
Rimola, A.; García-Tsao, G.; Navasa, M.; Piddock, L.J.; Planas, R.; Bernard, B.; Inadomi, J.M. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J. Hepatol., 2000, 32(1), 142-153.
[] [PMID: 10673079]
Kasztelan-Szczerbinska, B.; Słomka, M.; Celinski, K.; Serwacki, M.; Szczerbinski, M.; Cichoz-Lach, H. Prevalence of spontaneous bacterial peritonitis in asymptomatic inpatients with decompensated liver cirrhosis - a pilot study. Adv. Med. Sci., 2011, 56(1), 13-17.
[] [PMID: 21536540]
Badawy, A.A.; Zaher, T.I.; Sharaf, S.M.; Emara, M.H.; Shaheen, N.E.; Aly, T.F. Effect of alternative antibiotics in treatment of cefotaxime resistant spontaneous bacterial peritonitis. World J. Gastroenterol., 2013, 19(8), 1271-1277.
[] [PMID: 23483064]
Guler, K.; Vatansever, S.; Kayacan, S.M.; Salmayenli, N.; Akkaya, V.; Erk, O.; Palanduz, A. High sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites. Hepatogastroenterology, 2009, 56(90), 452-455.
[PMID: 19579619]
Lutz, P.; Nischalke, H.D.; Strassburg, C.P.; Spengler, U. Spontaneous bacterial peritonitis: The clinical challenge of a leaky gut and a cirrhotic liver. World J. Hepatol., 2015, 7(3), 304-314.
[] [PMID: 25848460]
Elefsiniotis, I.S.; Skounakis, M.; Vezali, E.; Pantazis, K.D.; Petrocheilou, A.; Pirounaki, M.; Papatsibas, G.; Kontou-Kastellanou, C.; Moulakakis, A. Clinical significance of serum procalcitonin levels in patients with acute or chronic liver disease. Eur. J. Gastroenterol. Hepatol., 2006, 18(5), 525-530.
[] [PMID: 16607149]
Tsiakalos, A.; Karatzaferis, A.; Ziakas, P.; Hatzis, G. Acute-phase proteins as indicators of bacterial infection in patients with cirrhosis. Liver Int., 2009, 29(10), 1538-1542.
[] [PMID: 19659507]
Hamed, M.; Hakim, H.; El-Masshad, N.; Eskandere, D. Serum procalcitonin and C-reactive protein in prediction of spontaneous bacterial peritonitis. Gastroenterol. Hepatol. J., 2017, 1(1), 22-23.
Preto-Zamperlini, M.; Farhat, S.C.; Perondi, M.B.; Pestana, A.P.; Cunha, P.S.; Pugliese, R.P.; Schvartsman, C. Elevated C-reactive protein and spontaneous bacterial peritonitis in children with chronic liver disease and ascites. J. Pediatr. Gastroenterol. Nutr., 2014, 58(1), 96-98.
[] [PMID: 24051480]
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.
[] [PMID: 24205495]
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.
[] [PMID: 28083050]
Urieli-Shoval, S.; Meek, R.L.; Hanson, R.H.; Eriksen, N.; Benditt, E.P. Human serum amyloid A genes are expressed in monocyte/macrophage cell lines. Am. J. Pathol., 1994, 145(3), 650-660.
[PMID: 8080047]
Menshawy, A.; Mattar, O.; Barssoum, K.; AboEl-Naga, A.M.; Salim, H.M.; Mohamed, A.M.F.; Elgebaly, A.; Abd-Elsalam, S. Safety and efficacy of Rifaximin in prophylaxis of spontaneous bacterial peritonitis: a systematic review and meta-analysis. Curr. Drug Targets, 2019, 20(4), 380-387.
[] [PMID: 30246636]
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, 20164013052
[] [PMID: 27340399]
Silverman, S.L.; Cathcart, E.S.; Skinner, M.; Cohen, A.S. The degradation of serum amyloid A protein by activated polymorphonuclear leucocytes: participation of granulocytic elastase. Immunology, 1982, 46(4), 737-744.
[PMID: 6921153]
Hayat, S.; Raynes, J.G. Acute phase serum amyloid A protein increases high density lipoprotein binding to human peripheral blood mononuclear cells and an endothelial cell line. Scand. J. Immunol., 2000, 51(2), 141-146.
[] [PMID: 10652160]
Badolato, R.; Wang, J.M.; Murphy, W.J.; Lloyd, A.R.; Michiel, D.F.; Bausserman, L.L.; Kelvin, D.J.; Oppenheim, J.J. Serum amyloid A is a chemoattractant: induction of migration, adhesion, and tissue infiltration of monocytes and polymorphonuclear leukocytes. J. Exp. Med., 1994, 180(1), 203-209.
[] [PMID: 7516407]

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