ABSTRACT
Spontaneous bacterial peritonitis [SBP] in cirrhotic patients is associated with an increased production and decreased metabolism of inflammatory mediators [cytokines] such as tumour necrosis factor a [TNF-alpha], interleukin 6 [IL-6] and interleukin 1-beta [IL-l beta]. The present study was designed to investigate the relationship between the development of SBP and the degree of inflammatory response in patients with liver cirrhosis and to assess the diagnostic value of the inflammatory mediators in cirrhotic patients with SBP. This study was carried out on 46 cirrhotic patients with SBP, 22 cirrhotic patients with ascites but without evidence of SBP, and 12 healthy subjects as a control group. All patients were subjected for history taking, clinical examination and abdominal ultrasound. Blood samples were collected for complete blood count [CBC], liver function tests and measurement of TNF-alpha, IL- l beta, and IL-6 levels [in patients and control]. Ascitic fluid samples were collected for measurement of TNF-alpha, IL- l beta, and IL-6 and for aerobic and anaerobic cultures [only in patients with SBP]. Cirrhotic patients with SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta and IL-6 than cirrhotic patients without SBP [despite that severity of liver disease was similar in the two groups] and normal control subjects [p<0.001]. Ascitic fluid TNF-alpha, IL- l beta and IL-6 were also higher in the cirrhotic patients with SBP than in plasma, [p<0.001 for each]. Also the plasma levels of TNF-alpha, IL- l beta and IL-6 in cirrhotic patients with SBP were significantly higher than in healthy control subjects [p<0.001]. There was a strong direct correlation between plasma and ascitic fluid levels of TNF-alpha, [r=0.9624, p<0.001] IL-l beta [r=0.4024, p<0.01], and IL-6 [r=0.2890, p<0.05] at the time of diagnosis of SBP. A significant correlation was also observed between TNF-alpha, IL- l beta, and IL-6 in ascitic fluid [r=1.0000, p<0.001] and in plasma [r=0.8500, p<0.001]. PMN cell count in ascites correlated significantly with the ascitic fluid level of IL- l beta [r=0.3156, p<0.05], but did not correlate with both TNF-alpha [r-0.0953, p>0.05] and IL-6 [r=0.0702, p>0.05]. Patients with culture-positive SBP showed significantly higher plasma and ascitic fluid levels of TNF-alpha, IL- l beta, and IL-6 than patients with culture-negative SBP. The PMN cell count in the ascitic fluid was also significantly higher in the culture-positive vs culture-negative SBP patients [6.813 +/- 0.24 vs 1.36110.07, p<0.001]. Cirrhotic patients with SBP display a marked increase of TNF-alpha, IL- l beta, and IL-6 levels in ascitic fluid and plasma. Specificity and sensitivity of these cytokines detection of SBP in cirrhotic patients strongly favor its measurement during acute phase of the disease