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

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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.	朱龍川, 朱萱. 血降鈣素原和C-反應蛋白對肝硬化腹水非多形核細胞性自發性細菌性腹膜炎的診斷意義. 中華消化雜志, 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.	韓濤. 肝硬化并發細菌感染的原因及防治措施. 臨床肝膽病雜志, 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, 胡偉明, 陳陽, 等. PCT在重癥急性胰腺炎的臨床應用初探. 中國普外基礎與臨床雜志, 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.	頡永樂, 劉健, 杜毅君, 等. 間斷性血液灌流和連續性血液濾過治療膿毒癥的療效比較. 中國普外基礎與臨床雜志, 2015, 22(7): 863-866.
18.	何平, 張小麗, 周夏袷, 等. 肝硬化患者腹水感染與血清降鈣素原的相關性分析. 中華醫院感染學雜志, 2016, 26(13): 2890-2892.
19.	魯炳懷, 時琰麗, 李雪清, 等. 血清降鈣素原在診斷老年肺部感染中的臨床價值. 首都醫科大學學報, 2014, 35(4): 456-462.
20.	繆希莉, 梅四清, 高貴民. 血清降鈣素原聯合炎癥指標對慢性重型乙型肝炎合并自發性細菌性腹膜炎的診斷價值. 廣東醫學, 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.	黨燕, 張立麗, 婁金麗, 等. 腹水及血漿降鈣素原在肝硬化合并自發性細菌性腹膜炎診斷中的價值. 首都醫科大學學報, 2015, 36(4): 597-600.
23.	吳學朕, 王永良, 羅浩元, 等. 利用ROC曲線分析PCT對肝硬化并發自發性細菌性腹膜炎的診斷價值. 國際檢驗醫學雜志, 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.	吳紅麗, 孫岳楓. 肝硬化伴自發性細菌性腹膜炎患者血漿PCT和CRP水平的變化及意義. 山東醫藥, 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. 朱龍川, 朱萱. 血降鈣素原和C-反應蛋白對肝硬化腹水非多形核細胞性自發性細菌性腹膜炎的診斷意義. 中華消化雜志, 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. 韓濤. 肝硬化并發細菌感染的原因及防治措施. 臨床肝膽病雜志, 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, 胡偉明, 陳陽, 等. PCT在重癥急性胰腺炎的臨床應用初探. 中國普外基礎與臨床雜志, 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. 頡永樂, 劉健, 杜毅君, 等. 間斷性血液灌流和連續性血液濾過治療膿毒癥的療效比較. 中國普外基礎與臨床雜志, 2015, 22(7): 863-866.
18. 何平, 張小麗, 周夏袷, 等. 肝硬化患者腹水感染與血清降鈣素原的相關性分析. 中華醫院感染學雜志, 2016, 26(13): 2890-2892.
19. 魯炳懷, 時琰麗, 李雪清, 等. 血清降鈣素原在診斷老年肺部感染中的臨床價值. 首都醫科大學學報, 2014, 35(4): 456-462.
20. 繆希莉, 梅四清, 高貴民. 血清降鈣素原聯合炎癥指標對慢性重型乙型肝炎合并自發性細菌性腹膜炎的診斷價值. 廣東醫學, 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. 黨燕, 張立麗, 婁金麗, 等. 腹水及血漿降鈣素原在肝硬化合并自發性細菌性腹膜炎診斷中的價值. 首都醫科大學學報, 2015, 36(4): 597-600.
23. 吳學朕, 王永良, 羅浩元, 等. 利用ROC曲線分析PCT對肝硬化并發自發性細菌性腹膜炎的診斷價值. 國際檢驗醫學雜志, 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. 吳紅麗, 孫岳楓. 肝硬化伴自發性細菌性腹膜炎患者血漿PCT和CRP水平的變化及意義. 山東醫藥, 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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