THE STUDY OF THE DIAGNOSTIC VALUE OF ASCETIC FLUID C-REACTIVE PROTEIN, CALPROTECTIN AND CALPROTECTIN –ASCETIC ALBUMIN RATIO IN PATIENT WITH SPONTANEOUS BACTERIAL PERITONITIS

Abstract

Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases. Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodule. Some patients with cirrhosis are completely asymptomatic and have a reasonably normal life expectancy (Friedman et al., 2008). Ascites is one of the major complications of liver cirrhosis and portal hypertension. Within 10 years of the diagnosis of cirrhosis, more than 50% of patients develop ascites The development of ascites is associated with a poor prognosis, with a mortality of 15% at one-year and 44% at five-year follow-up(Biecker,2011). Spontaneous bacterial peritonitis (SBP) is a common and frequently fatal bacterial infection of ascites occurring in patients with cirrhosis who have diverse symptomatology. The diagnosis is distinct from secondary peritonitis and hence is made in the absence of an intra-abdominal source of infection or inflammatory process(Dever and Sheikh, 2015). Signs and symptoms of spontaneous bacterial peritonitis (SBP) include fevers, chills, nausea, vomiting, abdominal pain and tenderness, general malaise, altered mental status, and worsening ascites (Lataet al., 2009). To date, early indicators for SB have not been determined. Although reagent strips have been tested for detecting SB, the results are unsatisfactory. The current guideline suggests that patients with ascites PMN counts <250/mm3 and signs of infection should be treated with antibiotics while awaiting culture results, which can be considered as management for SB. However, the “signs of infection” include several clinical manifestations only and no objective laboratory indices; therefore, this strategy would be implemented subjectively, leading to the abuse of antibiotics or delays in treatment(Zhuet al., 2016). Calprotectin is a heterodimer of two calcium-binding proteins present in the cytoplasm of neutrophils and expressed on the membrane of monocytes. Upon neutrophil activation or endothelial adhesion of monocytes, calprotectin is released and may be detected in serum or body fluids as potentially useful clinical inflammatory marker(Stríz and Trebichavský, 2004).