The Role of Serum Procalcitonin Level as an Early Marker of Ascitic Fluid Infection in Post Hepatitic Cirrhotic Patients (original) (raw)
Related papers
Al-Azhar Medical Journal, 2018
Background: Spontaneous bacterial peritonitis (SBP) is a serious, recurrent, and life-threatening condition developing in cirrhotic patients with a high mortality rate. Its diagnosis is based on ascitic fluid polymorphonuclear leukocytes (PMNs) to be more than 250/? L. Objectives: polymorphonuclear leukocytes (PMNs) to be more than 250/? L. Objective: The aim of the study was to evaluate the ascitic fluid and serum levels of calprotectin, procalcitonin (PCT) and endocan as appropriate markers for predicting and diagnosing SBP. Patients and Methods: This study was conducted on 90 patients with liver cirrhosis: 35 with decompensated cirrhosis and spontaneous bacterial peritonitis, 35 with decompensated cirrhosis without spontaneous bacterial peritonitis and 20 with compensated cirrhosis with no ascites. We evaluate the correlations of calprotectin, procalcitonin and endocan with indicators of infection and inflammation associated with spontaneous bacterial peritonitis in liver cirrhotic patients. Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and polymorphonuclear leukocytes, serum CRP, and blood leukocytes were analyzed. The control group (n = 30) composed of healthy blood donors with normal aminotransferase levels, normal complete blood counts and negative markers for viral hepatitis and HIV. Results: Ascitic fluid and serum levels of Calprotectin, procalcitonin, endocan, and PMNs, serum CRP and blood leukocytes were statistically elevated in cirrhotic patients with SBP than the control group and cirrhotic patients without SBP. There were statistically significant correlations between the existence of SBP with serum calprotectin (r = 0.512), serum procalcitonin (r= 0.370), serum endocan (r = 0.501), ascitic calprotectin (r = 508), ascitic procalcitonin (r = 0.501), ascitic endocan (r = 0.496), ascitic PMNs (r = 0.562), and CRP (r = 0.492), for all P < 0.001. The diagnostic accuracies of calprotectin, endocan, procalcitonin, and PMNs were elevated in progressive disease stage. Ascitic PMNs ≥ 250/mm³ had a sensitivity of 97% and specificity of 94.7%, Serum calprotectin levels ≥ 45 µg/ml had a sensitivity of 96% and specificity of 94%, ascitic calprotectin levels ≥ 0.95 µg/ml had a sensitivity of 95% and specificity of 89.2%, serum endocan levels ≥ 2.03 ng/ml had a sensitivity of 90% and specificity of 83.7%, ascitic procalcitonin levels ≥0.33ng/ml had a ARAFAT KASSEM et al. 258 sensitivity of 89.9% and specificity of 83.3%, ascitic endocan levels ≥ 0.65 ng/ml had a sensitivity of 88.9% and specificity of 78.5%, and lastly serum procalcitonin levels ≥2.50 ng/ml had a sensitivity of 87.9% and specificity of 76.8% for the diagnosis of SBP in decompensated cirrhotic patients. Conclusion: Ascitic fluid PMNs, serum calprotectin, ascitic calprotectin,serum endocan, ascitic procalcitonin, and serum procalcitonin, could be useful as powerful diagnostic markers to assess the progression of liver disease and early prediction of spontaneous bacterial peritonitis in cirrhotic patients.
Al-Azhar International Medical Journal
Background: Early diagnosis and prompt treatment of spontaneous bacterial peritonitis (SBP) due to end-stage liver disease is vital to shorten hospital stays and reduce mortality. Many studies have explored the potential usefulness of serum procalcitonin (PCT) in predicting SBP. Objective: to evaluate the overall diagnostic accuracy of PCT levels for identifying SBP due to end-stage liver disease. Patient and Methods: A prospective case control study was conducted on 60 post-HCV cirrhotic patients and 20 normal individuals (54 M and 26 F), at internal medicine department, Zagazig General Hospital. Full history, routine, physical examination and special investigations were taking. Results: The summary estimates for serum PCT in the diagnosis of SBP attributable to end stage liver disease were: sensitivity 95% and specificity 95%. Serum PCT is a relatively sensitive and specific test for the identification of SBP. However, due to the limited high-quality studies available, medical decisions should be carefully made in the context of both PCT test results and other clinical findings including diagnostic paracentesis. Conclusion: For our study we can concluded that: Serum Procalcitonin level can be used as a diagnostic test for rapid and accurate diagnosis of Spontaneous bacterial peritonitis in HCV cirrhotic patients with sensitivity and specificity about 95%.
Gut and Liver, 2015
Background/Aims: The diagnosis of spontaneous bacterial peritonitis (SBP) is based on a polymorphonuclear leukocytes (PMNs) exceeding 250/μL in ascitic fluid. The aim of the study was to evaluate serum procalcitonin and ascitic fluid calprotectin as accurate diagnostic markers for detecting SBP. Methods: Seventy-nine patients with cirrhotic ascites were included. They were divided into a SBP group, including 52 patients, and a non-SBP group of 27 patients. Serum procalcitonin, ascitic calprotectin, and serum and ascitic levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured using an enzyme-linked immunosorbent assay. Results: Serum procalcitonin and ascitic calprotectin were significantly higher in SBP patients than in non-SBP patients. Significant increases in both serum and ascitic levels of TNF-α and IL-6 were observed in SBP patients versus non-SBP patients. At a cutoff value of 0.94 ng/mL, serum procalcitonin had 94.3% sensitivity and 91.8% specificity for detecting SBP. In addition, at a cutoff value of 445 ng/mL, ascitic calprotectin had 95.4% sensitivity and 85.2% specificity for detecting SBP. Both were positively correlated with ascitic fluid proteins, PMN count, TNF-α, and IL-6. Conclusions: According to our findings, determination of serum procalcitonin levels and ascitic calprotectin appears to provide satisfactory diagnostic markers for the diagnosis of SBP. (Gut Liver 2016;10:624-631)
Ultra-sensitive procalcitonin may help rule out bacterial infections in patients with cirrhosis
Annals of Hepatology, 2014
Background. Bacterial infections are frequent complications in patients with cirrhosis. Since they are associated with poor outcomes, antibiotics are frequently over-prescribed. Surrogate markers of bacterial infections, like procalcitonin, are needed to better discriminate between infected and not infected patients. Aims. To evaluated the diagnostic accuracy of an ultra-sensitive procalcitonin assay for the diagnosis of bacterial infections in patients with cirrhosis. Material and methods. In a single-center prospective study, we determined the basal levels of procalcitonin in 106 episodes of admissions to the emergency department in 84 cirrhotic patients. Patients were classified as infected or not infected by two independent hepatologists blinded to the procalcitonin result. Results. The prevalence of bacterial infection was 28% (29 episodes). The median procalcitonin was significantly higher in the infected group than in the not infected group (0.45 vs. 0.061 ng/mL, p < 0.001). The diagnostic accuracy of procalcitonin for bacterial infection estimated by the ROC curve was 0.95 (CI: 95%, 0.91-0.99). When selecting a cutoff value of 0.098 ng/mL a sensitivity of 97% and a negative predictive value 98% were found. Conclusions. The use of an ultra-sensitive procalcitonin assay identifies patients with cirrhosis at very low risk of bacterial infections.
Survey of serum procalcitonin in cirrhotic patients
Acta medica Iranica, 2013
Procalcitonin (PCT) is a prohormone that has been used as a marker for the diagnosis of bacterial infections. The aim of this study was to survey PCT levels in patients with cirrhosis. Sixty-four patients with hepatic cirrhosis and 32 healthy blood donors were enrolled in this study. Serum PCT levels was detected using immunoluminometric assay. The rate of positive PCT was higher in patients with hepatitis C cirrhosis (92.8%) than the other groups. Among other cirrhotic patients, positive PCT levels were 77% for hepatitis B, 70% for cancer and 53.3% for unknown groups respectively. Serum procalcitonin levels were significantly higher in cirrhotic patients with bacterial infection (2.65±1.11 ng/ml) than those without infection (0.59±0.16 ng/ml, P=0.0001). PCT assay in cirrhotic patients may help diagnosis of sepsis and reduce unnecessary antibiotic use.
2020
Background: Spontaneous Bacterial Peritonitis (SBP) is a fatal complication of liver cirrhosis. Early diagnosis and appropriate management is crucial as regard patients' survival. Aim of Study: To assess the value of serum Pro-calcitonin in diagnosis of Spontaneous Bacterial Peritonitis (SBP) and predicting its response to treatment. Patients and Methods: Forty eight patients with ascites and suspicion of peritoneal fluid infection were enrolled. Diagnosis of SBP was confirmed by ascitic fluid analysis in 24 patients. Serum Procalcitonin was measured at time of admission for all enrolled patients and after 5 days of antibiotic treatment for those with SBP. Results: At a cut-off of value of 0.55ng/mL, procalcitonin had the best sensitivity (100%), specificity (83.3%) and (99.9%) accuracy in predicting SBP diagnosis. After 5 days of antibiotic treatment, thirteen patients (54.2%) responded to treatment. Procalcitonin had a (100%) sensitivity, (87.5%) specificity and (100%) accurac...
Cirrhotic Ascites management via procalcitonin level and a new approach B-mode gray-scale histogram
The Turkish Journal of Gastroenterology, 2016
Background/Aims: To determine the role of serum procalcitonin levels and ascites/subcutaneous echogenicity ratio (ASER) in predicting ascites infection in hospitalized cirrhotic patients. Materials and Methods: A total of 50 patients hospitalized because of cirrhosis-related ascites were included in this study. In these patients, 44% of ascites were infected (peritonitis), whereas 56% of ascites were sterile. These two groups were compared in terms of procalcitonin levels and ASER for predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of ASER, and the predicting outcome of ASER was compared with procalcitonin levels. Results: The ASER values of the patients with the diagnosis of infected ascites were significantly higher than in those with the diagnosis of sterile ascites (p<0.001). ROC analysis was performed to determine the diagnostic ASER value for infected ascites. An ASER greater than 0.0019 determined peritonitis with 95.5% sensitivity and 100% specificity. A procalcitonin level greater than 0.05 determined peritonitis with 86.4% sensitivity and 75% specificity. Using ROC analysis, an ASER greater than 0.0019 [area under curve (AUC): 0.974, 95% confidence interval (CI) (0.884-0.999, p<0.001)] was a significantly better diagnostic marker than a procalcitonin level >0.5 mg/dL [AUC: 0.860, 95% CI (0.884-0.999, p<0.001) (p<0.045)]. Conclusion: According to our findings, the determination of ASER and serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating ascites infections in hospitalized cirrhotic patients. ASER values significantly differentiate ascites infections better than procalcitonin levels.
Bangladesh Journal of Medicine
Spontaneous bacterial peritonitis (SBP)is an acute bacterial infection of ascitic fluid and one of the commonest complication of patients with cirrhosis presented with ascitis. Routine analysis of ascetic fluid particularly for polymorphonuclear leukocyte is an important tool for detecting spontaneous bacterial peritonitis including clinically unsuspected and asymptomatic patients also. Thus it helps in reducing mortality and morbidity by early and effective detection of spontaneous bacterial peritonitis. Objective: This study was carried out to evaluate the role of ascitic fluid analysis in early detection of spontaneous bacterial peritonitis and to document the proportion of spontaneous bacterial peritonitis present asymptomatically. Study design: This was a cross sectional observational study prospective in nature on 50 cases of diagnosed chronic liver disease patients in indoor of department of medicine of Sir Salimullah medical college Hospital, Dhaka from 02/01/13 to 01/07/13,...
The Open Biomarkers Journal
Background & Aims: The aim of the study was to evaluate serum c-reactive protein (CRP), ascitic procalcitonin (PCT) and monocyte chemotactic protein-1 (MCP-1) in the diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Methods: A cross-sectional analytic study that included 199 patients with decompensated cirrhosis (101 with SBP and 98 without SBP). Patients were classified according to Child-Pugh criteria. Ascitic PCT and MCP-1 were measured by enzyme-linked immunosorbent assay. Serum CRP, liver and renal functions were assessed. Results: Three markers are significantly elevated in SBP patients than those without ascites. Using the ROC curve at AUC 0.883 and a cut-off value of >186 ng/ml, the diagnostic performance of ascitic MCP-1 level was higher than CRP (AUC 0.562) and ascitic fluid procalcitonin (AUC 0.751) in the diagnosis of SBP. The sensitivity and specificity were 86.15% and 79.59% at the cutoff of 186 ng/ml for MCP-1, 65.4 and 75.5 at ≥ 1 ng/ml f...