الفهرس 
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Abstract
Cirrhosis represents the inal common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis.
Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. SBP is deined as the infection of AF in the absence of a contiguous source of infection and/or an intra-abdominal inlammatory focus. An AF-polymorphonuclear (PMN) leukocyte count more than or equal to 250/mm irrespective of the AF culture result is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently, the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner.
As a result of the potential for delays in the diagnosis of SBP, there has been interest in developing a surrogate test to identify an elevated AF-PMN cell count. Even when lowering the threshold for positivity, the sensitivity of the leukocyte reagent strip test only improved to 79%.
Lactoferrin is an iron-binding protein that is found mainly in external secretions such as breast milk and in PMN leukocytes. Lactoferrin is released from PMN leukocytes on activation of these cells, and its presence in body luids is proportional to the lux of neutrophils. It is hypothesized that measurement of AF lactoferrin could be clinically useful for the detection of SBP in patients with cirrhosis.
The aim of the study is to use AF lactoferrin for the diagnosis of SBP and to identify a clinically useful marker that can be used for future development of an important clinical, economic, and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites
This study was conducted on 60 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Gastroenterology and Hepatology department inpatient and outpatient clinics at Ain Shams University Hospitals and labs, from April 2023 to September 2023.
Inclusion criteria includes; Egyptian nationality, age above 18 years old, including males and females, accepting participation in the study and patients with decompensated chronic liver disease (child B and C cirrhosis with ascites). Exclusion criteria includes: Patients with ascites due to any other than liver cirrhosis, patients with evidence of active infection other than AF infection, patients with pre hospitalization antibiotic administration, patients with any other cause of neutrocytic ascites such as pancreatitis, appendicitis, tuberculosis, peritoneal carcinomatosis or haemorrhagic ascites, patient with a history of abdominal surgery within 3 months of the study or patient with hepatocellular carcinoma.
Patients were classiied into two groups:
• SBP group: Included 30 patients with cirrhotic ascites with spontaneous bacterial peritonitis (SBP).
• Control group: Included 30 patients with cirrhotic ascites without spontaneous bacterial peritonitis (non SBP).
Informed consent was taken from all patients and local ethical committee
All patients were subjected to the following:
1. Good history taking, general and local examination.
2. Laboratory investigations:
• Complete blood picture, CRP and ESR.
• Renal function test (blood urea, serum creatinine and uric acid).
• Liver function tests (ALT, AST, ALP, bilirubin, serum albumin, total protein and Prothrombin time and concentration).
• Arterial blood gases (pH, serum HCO3-, PaCo2- serum lactate.
• Serological tests for viral markers (HBsAg and HCV Ab).
3. Abdominal ultrasonography
Ultrasonographic evaluation included Diagnostic abdominal paracentesis: physical examination (colour and aspect), biochemical tests (total protein content, albumin, glucose, LDH, chloride, total and differential WBCs count, and lactoferrin level).
Statistical analysis of our results showed the following indings:
• Females were affected more than males by SBP,
• SBP has higher incidence in elderly compared to control group
• No signiicant difference between studied groups regards to risk factors and Child class (p>0.05).
• HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no signiicant difference between studied groups (p>0.05).
• Patients in SBP group showed positive reaction to CRP compared to control group with signiicant difference between them (p<0.05).
• No statistical signiicant differences between studied groups regards to abdominal ultrasonographic indings (p>0.05).
• Liver enzymes (ALT and AST) were higher in SBP patients compared to non SBP patients with signiicant difference between them (P<0.05).
• SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with signiicant difference between them (P<0.05).
• No statistical signiicant difference between studied groups regards to INR, Hb and MCH values (p>0.05).
• Ascetic luid of SBP patients has higher protein, TLC, PMN and lactoferrin compared to ascetic luid of non SBP patients with signiicant difference between them (P<0.05).
• The median AF lactoferrin level in patients with SBP group was signiicantly higher than the level in patients without SBP (217.5 ng/mL vs. 50.0 ng/mL) respectively with p< 0.001).
• No statistical signiicant difference between studied groups regards to ascetic luid chloride, glucose and LDH values (p>0.05).
• The AUC of AF lactoferrine in diagnosis of SBP in the 40 patients with ascites caused by cirrhosis was 0.896 (95 % CI, 0.639–0.987, p < 0.001).
At the cut-off level of ≥75 ng/mL, the sensitivity and speciicity of the test were 85 % and 100 %, respectively.
• While AUC for the use of AF TLC in diagnosis of SBP caused by cirrhosis was 0.863 (95 % CI, 0.717–0.951, p<0.001). At the cut-off level of ≥430 cell/mm3, the sensitivity and speciicity of the test were 100 % and 80 %, respectively.
• AUC for the use of AF proteins in diagnosis of SBP caused by cirrhosis was 0.686 (95 % CI, 0.520–0.823, p=0.029). At the cut-off level of ≥1.9 g/dl, the sensitivity and speciicity of the test were 65 % and 65 %, respectively.
• AF lactoferrin levels positively correlated with serum CRP (r = 0.485, p <0.001), TLC count (r = 0.340, p =0.042), AF TLC (r = 0.634, p <0.001), AF PMN count (r = 0.581, p <0.001).
• While AF lactoferrin levels negatively correlated with platelets count (r = - 0.392, p =0.018).