ABSTRACT
Background and aim of work: spontaneous bacterial peritonitis is an easily treatable disease but major obstacles were encountered in its diagnosis. The aim of this study was to evaluate the diagnostic efficacy of CRP and TNF-a in the ascitic fluid and their blood-ascitic gradient among cirrhotic patients with SBP versus those with sterile ascites
Subjects and methods: the study was conducted on 45 patients with liver cirrhosis. They had different etiologies, however all were positive for HCVAb. All patients were ascitic. According to the results of aerobic cultures in conjunction with·· polymorphnuclear neutrophil [PMN] count of ascitic fluids, cirrhotics were classified into two groups: Group I: 25 cirrhotic patients with SBP, [18 males and 7 females]. Their ages ranged from 25 to 69 years with mean +/- SD of 50.41 +/- 8.2 years. Group II: 20 cirrhotic patients with sterile ascites [9 males and 11 females]. Their ages ranged from 39 to 72 years with mean +/- _SD of 51.5 +/- 9.3 years. Both groups were subjected to the following: full history taking, clinical examination, complete blood picture, erythrocyte sedimentation rate, liver function tests, prothrombin time and concentration, renal function tests, fasting and 2 hours postprandial blood glucose, HBs Ag and HCV Ab. LDH, CRP and TNF-alpha were measured in serum and ascitic fluid. Ascitic fluids were also subjected to estimation of sugar, protein and albumin; counting of PMN/cmm and aerobic microbiological culture. Blood-ascitic gradients of albumin, LDH, CRP, TNF-alpha were calculated. Abdominal ultrasonography was done
Results: patients in group I showed a significant decrease of total protein in ascitic fluid in comparison with those in group II [P=0.04]. Ascitic fluid levels of LDH, CRP and TNF-et were higher in patients of group I than those in group II which were statistically significant as regard to LDH and CRP[p=0.0"3,0.001 respectively]. Serumascitic gradients of CRP and TNF-alpha were higher in-group I than group II. There was a significant difference between both groups regarding TNF-a. [P==0.04].There was a significant correlation between ascitic LDH and ascitic CRP [p=0.006]. There was a significant positive correlation between ascitic CRP and ascitic neutrophil count [p=0.002]. Sensitivity of ascitic fluid CRP and TNF-alpha were to be similar. However, the former had a higher specificity
Conclusion: ascitic fluid CRP can be correctly classify SBP and sterile ascites. It has the same sensitivity of ascitic TNF-alpha with a higher specificity It is considered as a cheap, easy and effective tool for diagnosis of SBP. · List of abbreviations: SBP: Spontaneous bacterial peritonitis. LDH: Lactate dehydrogenase. CRP: C-reactive protein. TNF-alpha: Tumour necrosis Factor alpha