Usefulness of AF Lactoferrin Levels in Patients with Liver Cirrhosis to Diagnose Spontaneous Bacterial Peritonitis

Abstract

irrhosis represents the final 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 defined as the infection of AF in the absence of a contiguous source of infection and/or an intra-abdominal inflammatory 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 fluids is proportional to the flux of neutrophils. It is hypothesized that measurement of AF lactoferrin could be clinically useful for the detection of SBP in patients with cirrhosis.