Use of Fecal calprotectin as a screening parameter for hepatic encephalopathy, spontaneous bacterial peritonitis and hepatorenal syndrome in Egyptian cirrhotic patients

Abstract

Calprotectin is a calcium and zinc-binding protein, representing more than 60% of the cytosolic proteins in neutrophils. The presence of calprotectin in feces quantitatively relates to neutrophil migration into the gastrointestinal (GI) tract. Therefore, it is considered as a valid marker of intestinal inflammation because it is released during cell activation and death. To assess the value of fecal calprotectin as a screening test for diagnosis of certain complication of cirrhosis as hepatic encephalopathy, spontaneous bacterial peritonitis and hepatorenal syndrome in Egyptian cirrhotic patients. This study was conducted at the faculty of medicine, Ain Shams university hospitals from March 2013 up to October 2014 included 80 patients, 20 controland they were divided into five groups: 1. 20 healthy non cirrhotic subjects as a control 2. 20 patients with liver cirrhosis without complications 3. 20 patients with liver cirrhosis complicated by SBP 4. 20 patients with liver cirrhosis complicated by HE 5. 20 patients with liver cirrhosis complicated by HRS We found that • There’s statistically highly significant difference between the studied groups(Control,Cirrhosis, SBP, HE and HRS) as regard various laboratory databy using one way ANOVA test.

• There’s statistically highly significant differencebetween studied groups(Control, Cirrhosis, SBP, HE and HRS) as regard fecal calprotectinby using one way ANOVA test • There’s statistically significant inverse correlation between fecal calprotectin versus albumin among cirrhotic group by using correlation coefficient test. • There’s statistically significant inverse correlation between fecal calprotectin versus Na among hepatic encephalopathy group by using correlation coefficient test. • There’s statistically significant inverse correlation between fecal calprotectin versus RBS among SBP group by using correlation coefficient test. • Fecal calprotectin has sensitivity of 90% and specificity of 60% in prediction of HE with PPV and NPV of 67% and 94% respectively at cut of value of 280mg/kg with AUC of 0.72. • Fecal calprotectin in SBP has sensitivity of 95% and specifity of 43% with PPV and NPV of 50% and 96% respectively at cut of value 190mg/kg with AUC of 0.47. • Fecal calprotectin in HRS has sensitivity of 90% and specificity of 88% with PPV and NPV of 90% and 97% respectively at cut of value of 340mg/kg with AUC of 0.94 .