Study of the Diagnostic and Prognostic value of Fecal calprotectin for hepatic encephalopathy 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 liver cirrhosis and certain complications of cirrhosis as hepatic encephalopathy in Egyptian cirrhotic patients. Also to access its prognostic value in these patients of HE after receiving rifaximin. This study was conducted at the faculty of medicine, Ain Shams University Hospitals from September 2015 up to March 2016 included 45 patients and 15 controls and they were divided into 3 groups: 1. 15 healthy non cirrhotic subjects as a control group 2. 15 patients with liver cirrhosis without HE 3. 30 patients with liver cirrhosis complicated by HE All subjects included in this study were subjected to: 1- History taking and complete clinical examination 2- Laboratory investigations: A) Complete blood count B) Biochemical Liver function tests: - Serum bilirubin (total and direct). - Serum albumin. - Prothrombin time, concentration and INR - Serum aspartate transaminase (AST) . - Serum alanine transaminase (ALT) . - Alkaline phosphatase. C) Renal functions tests: Serum urea, creatinine and blood urea nitrogen. D) Routine blood sugar, urine and stool analysis. E) Viral markers: HBsAg and HCVAb. F) Fecal calprotectin concentration by Enzyme Linked Immunosorbent Assay (ELISA) in the 3groups and in HE group after taking rifixamine. This study shows that: • There’s a highly statistically significant difference between the studied groups (Control, Cirrhosis, HE) as regard various laboratory data. There’s statistically significant inverse correlation between fecal calprotectin versus albumin among cirrhotic group . • There’s statistically significant inverse correlation between fecal calprotectin versus Na among hepatic encephalopathy group. • There’s a highly statistically significant difference between control and cirrhotic groups as regard fecal calprotectin by using one way ANOVA test. • There’s statistically highly significant difference between control and HE groups as regard fecal calprotectin by using one way ANOVA test. • There’s statistically highly significant difference between cirrhotic and HE groups as regard fecal calprotectin by using one way ANOVA test • There’s a highly statistically significant difference of level of fecal calprotectin between patients of HE after receiving rifaximine versus its value before using the drug. • 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. So, fecal calprotectin could represent a useful diagnostic tool for liver cirrhosis&hepatic encephalopathy. It may facilitate the grading of HE-severity which may be sometimes subjective when using only clinical criteria . Also, it is a useful prognostic marker for HE patients after receiving rifaximine.