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Year : 2019  |  Volume : 3  |  Issue : 2  |  Page : 527-537

The value of ascitic fluid calprotectin and calprotectin-to-albumin ratio in the diagnosis and prognosis of spontaneous bacterial peritonitis

1 Internal Medicine Department, Faculty of Medicine For Girls, Al-Azhar University, Cairo, Egypt
2 Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt

Correspondence Address:
MD Samia T Ali
Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjamf.sjamf_32_19

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Introduction Spontaneous bacterial peritonitis (SBP) is a potentially fatal condition, characterized by infection of ascitic fluid (AF) in the absence of any intra-abdominal surgically treatable source of infection. It is the most frequent and severe complication of cirrhotic ascites. SBP is a condition that requires a high index of suspicion, rapid and accurate diagnosis, in addition to prompt and effective therapy. Aim The aim of this study was to evaluate AF calprotectin as a diagnostic marker in detecting SBP. In addition, we have evaluated AF calprotectin-to-albumin ratio in the diagnosis and prognosis of SBP. Patients and methods A total of 72 patients with cirrhotic ascites were included in this study. They were divided into two groups: SBP group included 50 patients with cirrhotic ascites and SBP diagnosed by presence of polymorphonuclear leukocyte count at least 250 cells/mm3 in AF with or without positive AF culture, and non-SBP group included 22 patients with cirrhotic ascites without evidence of SBP. All patients were subjected to complete clinical evaluation, laboratory investigations, diagnostic abdominal paracentesis, serum and AF C-reactive protein levels, which were assessed quantitatively, and AF calprotectin levels, which were measured by quantitative sandwich enzyme-linked immunosorbent assay. Results AF calprotectin was significantly elevated in patients with SBP in comparison with non-SBP patients (P<0.001), with the best cutoff value for the detection of SBP (372 ng/ml) with a sensitivity, specificity, positive predictive value, negative predictive value, and an accuracy of 100% for each. Moreover, there was a positive correlation with total leukocytic count, polymorphonuclear leukocyte, and C-reactive protein in serum and AF. Moreover, calprotectin-to-albumin ratio was increased in SBP group versus non-SBP group (P<0.001). Conclusion AF calprotectin can be used as a valuable marker in rapid diagnosis of SBP. Moreover, calprotectin-to-albumin ratio in ascites is useful in the diagnosis of SBP, as well as it provides prognostic information on short-term survival of patients with SBP with follow-up treatment.

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