PROTEIN-1 BETA IN PATIENTS WITH SPONTANEOUS BACTERIAL PERITONITIS BEFORE AND AFTER ANTIBIOTIC THERAPY

Abstract

Spontaneous bacterial peritonitis may be fatal,but reversible cause of deterioration in patients with advanced cirrhosis. It can be defined as a bacterial infection of the ascitic fluid in the absence of a focal contiguous source. This infection almost occurs in case of severe liver disease. The microorganisms more commonly isolated from cases of SBP are Escherichia coli (70%), Klebsiella species (10%), Proteus species, Enterococcus faecalis (4% each), Pseudomonas species (2%) and others (6%). Risk factors for thedevelopment of SBP include ascitic fluid total protein less than 1 g/dL,gastrointestinal hemorrhage and previous history of SBP. Risk factors for the development of SBP include ascitic fluid total protein less than 1 g/dL, gastrointestinal hemorrhage, and previous history of SBP. The diagnosis of confirmed spontaneous bacterial peritonitis depends on an elevated ascitic fluid absolute polymorphonuclear leukocyte count of at least 250 cells/mm3 and a positive ascitic fluid bacterial culture without an obvious intra-abdominal source of infection. Ascitic fluid diagnostic test should be performed before initiation of treatment with even a single dose of broad- spectrum antibiotics can lead to no growth on bacterial culture in 86% of cases Macrophage inflammatory protein type 1 beta (MIP-1β, CCL4 ) belongs to the family of chemokines, best known for their chemotactic and proinflammatory effects. MIP-1β is an acidic protein composed of 69 amino acids that is produced by many cells, particularly macrophages, dendritic cellsand lymphocytes. Synthesis of MIP-1β is stimulated with bacterial endotoxins.MIP-1β is responsible for the activation of PMN and is involved inacute neutrophilic inflammation. This protein is most effective at augmenting adhesion of CD8 (+) T-cells to the vascular cell adhesionmolecule (VCAM-1). The aim of this study was evaluation ofefficacy of macrophage inflammatory protein-1 beta(MIP-1β) measured in ascitic fluid for diagnosis of SBP and its usefulness as prognostic marker after antibiotic therapy in SBP. This study was conducted on 50 patients with chronic liver disease and ascites divided into two groups: • Group 1 (25 patients): SBP patients proved on clinical signs and cell count (>250 cells/mm3). • Group 2 (25 patients): Control group patients with ascites but no SPB. All patients were subjected to thorough history taking and general examination, abdominal examination, Laboratory investigations including liver function tests (ALT, AST, ALP, Total Bilirubin, Direct Bilirubin, serum albumin and INR), renal function tests (urea and creatinine), complete blood picture, C-reactive protein, viral markers (serum HCV-Ab and HBs Ag), alpha fetoprotein, ascitic fluid analysis, Ascitic level of macrophage inflammatory protein-1 beta (MIP-1b) by ELISA and abdominal Ultrasonography. After 3 days of antibiotic therapy, Group 1 was investigated for change in PMN count and level of MIP-β in ascitic fluid

In this study, there was no significant difference between the two groups regarding demographic data of patients, medical history including DM and HTN.