Vascular endothelial growth factor and soluble adhesion molecules as a diagnostic markers for spontaneous bacterial peritonitis in cirrhotic liver disease

ABSTRACT

Spontaneous bacterial peritonitis [SBP] is a frequent and severe complication in cirrhotic patients with ascites that usually results in renal failure and death despite the efficacy of the current antibiotic therapy. The aim of this study was determine serum and ascitic fluid of soluble-L selectin [s-L Selectin], intracellular adhesion molecule-1 [ICAM-1], Vascular cell adhesion molecule-1 [VCAM-1] and vascular endothelial growth factor [VEGF] in cirrhotic patients, and to search for a relationship between them and SBP. This study was performed on 30 cirrhotic patients with SBP. Their ages ranged [from 38-55 years] with mean of [32 +/- 5.5], 30 cirrhotic patients with non-infected ascites; their ages ranged [from 30-52 years] with mean of [35 +/- 6.5]. This group considered as cirrhotic control group and 20 healthy control subjects their ages ranged [from 28-55 years] with mean of [30 +/- 7.5]. Serum and ascitic fluid of adhesion molecules as well as VEGF levels were significantly higher in cirrhotic patients with SBP as well as cirrhotic patients with non-infected ascites as compared to healthy control group. There were significant increase in serum and ascitic fluid level of leukocyte, PMN and ICAM-1 in SBP as compared to cirrhotic with non-infected ascites. There was non-significant decrease in serum and AF level of VEGF in cirrhotic control group as compared to SBP group. The ascitic fluid PMN and s-L Selectin were higher in culture positive SBP patients particularly in those with gram positive isolates, where these are non-significant increase in serum and ascitic fluid level of VEGF in culture positive SBP than culture negative cases. Positive correlation was found between serum and ascitic fluid level of ICAM-1 in SBP and non-infected cirrhotic group. Also, positive correlation was found between VEGF levels in serum ascetic fluid levels in both cirrhotic groups [SBP and non-infected cirrhotic group]. These data suggest that Significant elevated level of VEGF in both SBP and non infected cirrhotic patient may have pathophsiological consequences of local regulation of vascular tone and endothelial permeability, significant elevated level of adhesion molecules in both SBP and non-infected cirrhotic patients are due to inflammatory response and endothelial cell activation. Serum and ascetic fluid of ICAM-1 can be used as useful marker for diagnosis of SBP and for monitoring the treatment of cirrhotic patients