Diagnostic value of serum procalcitonin and C-reactive protein for spontaneous bacterial peritonitis in patients with liver cirrhosis ascites_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIONG Can ,  LIU Qi , LEI Jingjing , HE Xiaoyan

Department of Digestive System, Baiyun Hospital Affiliated to Guizhou Medical University, Guiyang 550014, P.R.China;

Corresponding author：

LIU Qi, Email: gyqiliu@sina.com

Keywords：

liver cirrhosis; ascites; spontaneous bacterial peritonitis; C reactive protein; procalcitonin

DOI：

10.7507/1007-9424.201606007

Video：

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Objective To investigate predictive value of procalcitonin (PCT) and C-reactive protein (CRP) levels for spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis ascites. Methods The clinical data of 140 patients with liver cirrhosis ascites treated in our hospital from January 2012 to January 2016 were retrospectively analyzed. According to the presence of SBP, these patients were divided into SBP group and non-SBP group. The clinical data were compared between these two groups. The receiver operating characteristic (ROC) curve was constructed to assess their sensitivities and specificities of PCT and CRP for diagnosis of SBP. Results The PCT and CRP levels of the SBP group were significantly higher than those of the non-SBP group (P<0.05). The differences of serum ALT, AST and white cell count between the SBP group and the non-SBP were not statistically significant (P>0.05). The ROC curve analysis showed that the area under the ROC curve of PCT and CRP were 0.895 and 0.926, their corresponding cut-off value 2.1 μg/L and 24.8 mg/L, the sensitivities were 86.9% and 89.5%, the specificities were 85.1% and 83.5%, respectively. Conclusion Abnormally elevated PCT and CRP levels might have an important detective value for SBP in patients with liver cirrhosis ascites.

Citation： XIONGCan, LIUQi, LEIJingjing, HEXiaoyan. Diagnostic value of serum procalcitonin and C-reactive protein for spontaneous bacterial peritonitis in patients with liver cirrhosis ascites. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 228-231. doi: 10.7507/1007-9424.201606007 Copy

1.	Cai ZH, Fan CL, Zheng JF,et al. Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis. BMC Infect Dis, 2015, 15: 55.
2.	Moreau R, Jalan R, Gines P,et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013, 144(7): 1426-1437, 1437.e1-9.
3.	Arabi M, Dara I, Memish Ziad,et al. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. Hepatology, 2012, 56(6): 2305-2315.
4.	朱龙川, 朱萱. 血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义. 中华消化杂志, 2016, 36(3): 161-166.
5.	Runyon A; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4): 1651-1653.
6.	European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol, 2010, 53(3): 397-417.
7.	Acharya SK. Difficult to treat spontaneous bacterial peritonitis. Trop Gastroenterol, 2013, 34(1): 7-13.
8.	Pleguezuelo M, Benitez JM, Jurado J,et al. Diagnosis and management of bacterial infections in decompensated cirrhosis. World J Hepatol, 2013, 5(1): 16-25.
9.	韩涛. 肝硬化并发细菌感染的原因及防治措施. 临床肝胆病杂志, 2015, 31(9): 1415-1417.
10.	Bloos F, Reinhart K. Rapid diagnosis of sepsis. Virulence, 2014, 5(1): 154-160.
11.	Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Mater Sociomed, 2013, 25(4): 277-281.
12.	Gómez-Cerquera JM, Daroca-Pérez R, Baeza-Trinidad R,et al. Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients. Enferm Infecc Microbiol Clin, 2015, 33(8): 521-524.
13.	Rahimzadeh N, Otukesh H, Hoseini R,et al. Serum procalcitonin level for prediction of high-grade vesicoureteral reflux in urinary tract infection. Iran J Kidney Dis, 2014, 8(2): 105-108.
14.	李懋, 胡伟明, 陈阳, 等. PCT在重症急性胰腺炎的临床应用初探. 中国普外基础与临床杂志, 2015, 22(1): 28-32.
15.	Asadi Gharabaghi M, Allameh SF, Foroutan H,et al. Blood procalcitonin predicts spontaneous bacterial peritonitis in patients with cirrhosis and ascites. Middle East J Dig Dis, 2015, 7: 189-190.
16.	Cardoso FS, Ricardo LB, Oliveira AM,et al. C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol, 2013, 25(7): 784-789.
17.	颉永乐, 刘健, 杜毅君, 等. 间断性血液灌流和连续性血液滤过治疗脓毒症的疗效比较. 中国普外基础与临床杂志, 2015, 22(7): 863-866.
18.	何平, 张小丽, 周夏袷, 等. 肝硬化患者腹水感染与血清降钙素原的相关性分析. 中华医院感染学杂志, 2016, 26(13): 2890-2892.
19.	鲁炳怀, 时琰丽, 李雪清, 等. 血清降钙素原在诊断老年肺部感染中的临床价值. 首都医科大学学报, 2014, 35(4): 456-462.
20.	缪希莉, 梅四清, 高贵民. 血清降钙素原联合炎症指标对慢性重型乙型肝炎合并自发性细菌性腹膜炎的诊断价值. 广东医学, 2016, 37(17): 2625-2628.
21.	Cekin Y, Cekin AH, Duman A,et al. The role of serum procalcitonin levels in predicting ascitic fluid infection in hospitalized cirrhotic and non-cirrhotic patients. Int J Med Sci, 2013, 10(10): 1367-1374.
22.	党燕, 张立丽, 娄金丽, 等. 腹水及血浆降钙素原在肝硬化合并自发性细菌性腹膜炎诊断中的价值. 首都医科大学学报, 2015, 36(4): 597-600.
23.	吴学朕, 王永良, 罗浩元, 等. 利用ROC曲线分析PCT对肝硬化并发自发性细菌性腹膜炎的诊断价值. 国际检验医学杂志, 2016, 37(14): 1928-1932.
24.	Lin KH, Wang FL, Wu MS,et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis. Diagn Microbiol Infect Dis, 2014, 80(1): 72-78.
25.	吴红丽, 孙岳枫. 肝硬化伴自发性细菌性腹膜炎患者血浆PCT和CRP水平的变化及意义. 山东医药, 2015, 55(9): 56-58.

1. Cai ZH, Fan CL, Zheng JF,et al. Measurement of serum procalcitonin levels for the early diagnosis of spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis. BMC Infect Dis, 2015, 15: 55.
2. Moreau R, Jalan R, Gines P,et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 2013, 144(7): 1426-1437, 1437.e1-9.
3. Arabi M, Dara I, Memish Ziad,et al. Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis. Hepatology, 2012, 56(6): 2305-2315.
4. 朱龙川, 朱萱. 血降钙素原和C-反应蛋白对肝硬化腹水非多形核细胞性自发性细菌性腹膜炎的诊断意义. 中华消化杂志, 2016, 36(3): 161-166.
5. Runyon A; AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4): 1651-1653.
6. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol, 2010, 53(3): 397-417.
7. Acharya SK. Difficult to treat spontaneous bacterial peritonitis. Trop Gastroenterol, 2013, 34(1): 7-13.
8. Pleguezuelo M, Benitez JM, Jurado J,et al. Diagnosis and management of bacterial infections in decompensated cirrhosis. World J Hepatol, 2013, 5(1): 16-25.
9. 韩涛. 肝硬化并发细菌感染的原因及防治措施. 临床肝胆病杂志, 2015, 31(9): 1415-1417.
10. Bloos F, Reinhart K. Rapid diagnosis of sepsis. Virulence, 2014, 5(1): 154-160.
11. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Mater Sociomed, 2013, 25(4): 277-281.
12. Gómez-Cerquera JM, Daroca-Pérez R, Baeza-Trinidad R,et al. Validity of procalcitonin for the diagnosis of bacterial infection in elderly patients. Enferm Infecc Microbiol Clin, 2015, 33(8): 521-524.
13. Rahimzadeh N, Otukesh H, Hoseini R,et al. Serum procalcitonin level for prediction of high-grade vesicoureteral reflux in urinary tract infection. Iran J Kidney Dis, 2014, 8(2): 105-108.
14. 李懋, 胡伟明, 陈阳, 等. PCT在重症急性胰腺炎的临床应用初探. 中国普外基础与临床杂志, 2015, 22(1): 28-32.
15. Asadi Gharabaghi M, Allameh SF, Foroutan H,et al. Blood procalcitonin predicts spontaneous bacterial peritonitis in patients with cirrhosis and ascites. Middle East J Dig Dis, 2015, 7: 189-190.
16. Cardoso FS, Ricardo LB, Oliveira AM,et al. C-reactive protein prognostic accuracy in acute pancreatitis: timing of measurement and cutoff points. Eur J Gastroenterol Hepatol, 2013, 25(7): 784-789.
17. 颉永乐, 刘健, 杜毅君, 等. 间断性血液灌流和连续性血液滤过治疗脓毒症的疗效比较. 中国普外基础与临床杂志, 2015, 22(7): 863-866.
18. 何平, 张小丽, 周夏袷, 等. 肝硬化患者腹水感染与血清降钙素原的相关性分析. 中华医院感染学杂志, 2016, 26(13): 2890-2892.
19. 鲁炳怀, 时琰丽, 李雪清, 等. 血清降钙素原在诊断老年肺部感染中的临床价值. 首都医科大学学报, 2014, 35(4): 456-462.
20. 缪希莉, 梅四清, 高贵民. 血清降钙素原联合炎症指标对慢性重型乙型肝炎合并自发性细菌性腹膜炎的诊断价值. 广东医学, 2016, 37(17): 2625-2628.
21. Cekin Y, Cekin AH, Duman A,et al. The role of serum procalcitonin levels in predicting ascitic fluid infection in hospitalized cirrhotic and non-cirrhotic patients. Int J Med Sci, 2013, 10(10): 1367-1374.
22. 党燕, 张立丽, 娄金丽, 等. 腹水及血浆降钙素原在肝硬化合并自发性细菌性腹膜炎诊断中的价值. 首都医科大学学报, 2015, 36(4): 597-600.
23. 吴学朕, 王永良, 罗浩元, 等. 利用ROC曲线分析PCT对肝硬化并发自发性细菌性腹膜炎的诊断价值. 国际检验医学杂志, 2016, 37(14): 1928-1932.
24. Lin KH, Wang FL, Wu MS,et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection in patients with liver cirrhosis: a systematic review and meta-analysis. Diagn Microbiol Infect Dis, 2014, 80(1): 72-78.
25. 吴红丽, 孙岳枫. 肝硬化伴自发性细菌性腹膜炎患者血浆PCT和CRP水平的变化及意义. 山东医药, 2015, 55(9): 56-58.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnostic value of serum procalcitonin and C-reactive protein for spontaneous bacterial peritonitis in patients with liver cirrhosis ascites

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