الفهرس 
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Abstract
Spontaneous bacterial peritonitis (SBP) is one of the most known complications in cirrhotic patients. SBP is diagnosed if ascitic fluid neutrophils are > 250/mm3. False-negative results can happen due to lysis of the PMNs during transfer to the laboratory. Manual counting of the ascitic fluid PMN depends on the operator and can affect the diagnosis. So, finding new biomarkers can help in diagnosis and treatment of SBP.
Calprotectin .is.an acute phase inflammatory protein which has regulatory and antimicrobial functions and its existence in body fluids is related to the neutrophils influx. It was identified as a hopeful inflammatory marker. Homocysteine (Hcy) is an amino acid which can be found in small amounts in all cells. The liver has a crucial role in Hcy metabolism.
We aimed in this study to evaluate and compare the accuracy of ascitic Homocysteine and Calprotectin in diagnosis and prognosis of SBP.
In this prospective study in 1 year, we recruited 70 cirrhotic patients with ascites referred to the Tropical Medicine and Gastroentrology Department at Sohag University Hospital. All included patients were subjected to: Complete history taking, clinical examination, routine laboratory investigations and abdominal ultrasonography. Also, diagnostic abdominal paracentesis was done for chemical analysis for protein, Homocysteine and Calprotectin level by ELISA and cellular examination for total WBCs and PMN count.
We categorized them into 2 groups: SBP patients (65.7%) and non-SBP patients (34.3%) (as a control) according to PMN count in ascitic fluid. Most patients were females (52.9%) versus 47.1% males with a mean age of (57.3 ± 11.72) years. Nine (12.9%) patients died during admission while 87.1% survived.
In our study, ascitic Calprotectin was significantly higher in SBP patients than non-SBP. We found that ascitic Calprotectin at a cut-off value of 142 ng/mL had a sensitivity of 71.7% and specificity 91.7% with NPV 62.9% and PPV 94.2% for SBP diagnosis. Also, ascitic Hcy was significantly higher in SBP patients. Ascitic Hcy at a cut-off value of 3.6 μmol/l had a sensitivity of 69.9% and specificity 91.7% with NPV 61.1% and PPV 94.1%for SBP diagnosis. We found that the combined use of both Homocysteine and Calprotectin in SBP diagnosis does not add much to using any of them alone.
We found that Calprotectin /albumin ratio was significantly lower in Child C. On the other hand, Homocysteine level, Homocysteine /albumin and Homocysteine /protein ratios were significantly higher in Child C patients which can predict liver disease severity.
Our study showed that ascitic Homocysteine and Calprotectin levels were not associated with mortality, so they can’t be used for SBP prognosis.
In conclusion, both ascitic Hcy and Calprotectin were significantly higher in cirrhotic patients with SBP than in non-SBP patients. So, they can be used as dependable markers for diagnosis of SBP. Homocysteine , Homocysteine /albumin ratio and Homocysteine /protein can predict liver disease severity based on Child score. Child score, hepatic encephalopathy and hepatorenal syndrome were significantly associated with mortality in SBP patients.
Recommendations
We need larger samples to evaluate Calprotectin and Hcy for SBP diagnosis and prognosis. Also, we need to study a group of cirrhotic patients with other infections to judge if Calprotectin and Hcy are specific for SBP. In addition, we need to study serum beside ascitic Calprotectin and Hcy. At last, we studied only short-term mortality in-hospital. So, we recommend following up patients after discharge to study long-term mortality.