الفهرس 
LIVER CIRRHOSIS OVERVIEWOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis is the clinical end-stage of different
entities of chronic liver disease when patients suffer from
substantial mortality and morbidity, both of which are
positively correlated with disease severity. Ascites is the most
common complication, and around 60% of patients with
compensated cirrhosis develop ascites within 10 years of
disease onset (Ali and Mohamed, 2019).
Spontaneous bacterial peritonitis (SBP) is an important
cause of morbidity and mortality in cirrhotic patients with
ascites. SBP is estimated to affect 10%-30% of cirrhotic
patients hospitalized with ascites, and mortality in this group
approaches 30%. Many of these patients are asymptomatic, and
it is therefore recommended that all patients with ascites
undergo paracentesis at the time of admission to confirm the
SBP status. Although SBP is less prevalent in an outpatient
setting, it is reasonable to also evaluate the ascitic fluid of
outpatients because of the high mortality associated with SBP
(Ali and Mohamed, 2019).
This study was designed as a case-control study for
evaluation of ascitic calprotectin as a diagnostic & prognostic
test for spontaneous bacterial peritonitis. The study was
conducted on 50 patients attended internal medicine department in El Dmerdash teaching hospital of Ain Shams university
during 2018/2019. The patients were divided into 2 groups:
group A: 10 cirrhotic ascitic patients without spontaneous
bacterial peritonitis at the time of presentation.
group B: 40 patients with cirrhotic ascites with spontaneous
bacterial peritonitis (diagnosed by presence of more than
250 PMNs in ascitic fluid and /or positive culture).
The present study showed best cut-off value of ascitic
calprotectin in diagnosis of SBP among cirrhotic patients is at ≤
320 pg/ml which had sensitivity 95%, specificity 90%, PPV
74.5%, NPV 81.8%, accuracy 94.1%.
Regarding the ascitic calprotectin after treatment showed
decreasing levels correlated with recovery among SBP patients
with cut off ≤340 pg/ml had sensitivity 82.5%, specificity
78.0%, PPV 75.0%, NPV 84.8%, accuracy 82.6% in cirrhotic
patients with SBP after treatment.
Also, the present study found that ascitic calprotectin is
an indicator of poor prognosis among SBP cirrhotic patients
after treatment at cut off value ≤ 780 pg/ml had sensitivity
82.86%, specificity 100%, PPV 100%, NPV 45.5%, accuracy
96.3% in prediction of poor prognosis.