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. 2022 Oct 25:7:36.
doi: 10.21037/tgh-19-297. eCollection 2022.

Procalcitonin and C-reactive protein in the diagnosis of spontaneous bacterial peritonitis

Rajanshu Verma  1 , Sanjaya K Satapathy  2   3 , Muhammad Bilal  4
Affiliations

Procalcitonin and C-reactive protein in the diagnosis of spontaneous bacterial peritonitis

Rajanshu Verma et al. Transl Gastroenterol Hepatol. .

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis and is associated with high morbidity and mortality. Rapid institution of appropriate antibiotics is central to the improved patient outcome. Correctly obtaining ascites fluid for analysis has several technical and logistic limitations resulting in overuse of empiric antibiotics when patients are admitted to the hospital with suspected SBP. Procalcitonin and C-reactive protein (CRP) are non-invasive markers of infection. We conducted a study to illustrate the role of these markers in making the diagnosis of SBP in patients with cirrhosis.

Methods: A total of 45 patients were enrolled in this prospective cohort study, 14 (31.1%) of which were found to have SBP. Ascitic fluid neutrophils, serum procalcitonin and CRP levels were measured prior to initiation of antibiotics and these parameters were compared between the two groups. Area under receiver operator characteristic (AUROC) curves were used to assess the diagnostic accuracy of procalcitonin and CRP in this population. We defined neutrocytic SBP group as a combination of patients who had classic SBP (positive ascitic culture and >250 neutrophils/mm3) and culture-negative neutrocytic ascites.

Results: Serum procalcitonin (2.81±2.59 vs. 0.43±0.48 ng/mL; P=0.0032), serum CRP (60.30±44.48 vs. 22.2±23.28; P=0.0055) and ascitic fluid neutrophil levels (49.23±30.90 vs. 16.7±20.39; P=0.0064) were significantly higher in SBP group than non-SBP group. AUROC for procalcitonin (cut-off >2.0 ng/mL) was 0.75 (95% CI, 0.61-0.88), CRP (cut-off >3.0 mg/L) was 0.55 (95% CI, 0.43-0.68) and for procalcitonin combined with CRP was 0.76 (95% CI, 0.61-0.90) for diagnosing all-cause SBP. In a subgroup analysis of patients with neutrocytic SBP, AUROC for procalcitonin was 0.88 (95% CI, 0.74-1.00), CRP was 0.62 (95% CI, 0.45-0.79) and for procalcitonin combined with CRP was 0.93 (95% CI, 0.81-1.00). Addition of CRP to procalcitonin did not significantly change the AUROC for diagnosis of SBP.

Conclusions: Serum procalcitonin could be used as an adjunctive non-invasive biomarker in diagnosing SBP with a high degree of accuracy in cirrhotic patients. Addition of CRP does not seem to significantly increase the diagnostic accuracy of procalcitonin.

Keywords: C-reactive protein (CRP); Procalcitonin; diagnosis; liver cirrhosis; peritonitis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-19-297/coif). SKS reports grants from Gilead Sciences, Conatus Pharma, Intercept Pharma, Genfit, Bayer, Exact Sciences, Biotest, Shire NASH and Enanta, outside the submitted work; he reports Speaker’s Bureau from Intercept Pharma, Alexion and Dova, outside the submitted work; he is on Advisory Board of Bayer and Biotest, outside the submitted work. SKS serves as an Editor-in-Chief of Translational Gastroenterology and Hepatology. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Comparison of ROC curves showing AUROC for procalcitonin, CRP, and combined effect of procalcitonin-CRP in predicting ‘all cause SBP’. ROC, receiver operator characteristics; AUROC, area under receiver operator characteristic; CRP, C-reactive protein; SBP, spontaneous bacterial peritonitis.
Figure 2
Figure 2
Comparison of ROC curves showing AUROC for procalcitonin, CRP, and combined effect of procalcitonin/CRP in predicting ‘neutrocytic SBP’. ROC, receiver operator characteristics; AUROC, area under receiver operator characteristic; CRP, C-reactive protein; SBP, spontaneous bacterial peritonitis.
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References

    1. Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis--in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol 2001;96:1232-6. - PubMed
    1. Mostafa MS, El-Seidi EA, Kassem AM, et al. Detection of ascitic fluid infections in patients with liver cirrhosis and ascites. Arab J Gastroenterol 2011;12:20-4. 10.1016/j.ajg.2011.01.004 - DOI - PubMed
    1. Facciorusso A, Antonino M, Orsitto E, Sacco R. Primary and secondary prophylaxis of spontaneous bacterial peritonitis: current state of the art. Expert Rev Gastroenterol Hepatol 2019;13:751-9. 10.1080/17474124.2019.1644167 - DOI - PubMed
    1. Facciorusso A, Papagiouvanni I, Cela M, Buccino VR, Sacco R. Comparative efficacy of long-term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis. Liver Int 2019;39:1448-58. 10.1111/liv.14109 - DOI - PubMed
    1. European Association for the Study of the Liver . EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69:406-60. 10.1016/j.jhep.2018.03.024 - DOI - PubMed