Serum and ascitic fluid high sensitive C reactive protein as prognostic marker in patients with spontaneous bacterial peritonitis

ABSTRACT

Background: Spontaneous Bacterial Peritonitis (SBP) is the most frequent bacterial infection in cirrhotic patients with ascites. The mortality rate in those patients ranges from 40-70%.Aim: to assess level of serum and ascetic fluid polymorph nuclear leucocytes (PMN), high sensitive C reactive protein (hs-CRP) in patients with SBP before and after treatment. Methods: A cohort study was done on 114 patients SBP admitted in the Internal Medicine, Faculty of Medicine, Zagazig University during the period from December 2017 to September 2018. All patients were subjected to full history taking, thorough clinical examination, routine laboratory investigation, ultrasonography and ascitic fluid sampling. They was followed up for 5 days from starting treatment by parenteral third generation cephalosporin and peripheral blood (PMN), serum (hs-CRP), ascitic fluid PMN and hs-CRP were measured again.Results: the largest percentage of the patients were male, had posthepatitic C cirrhosis and child C score. There was statistically non-significant difference between antibiotic responders and non-responders regarding peripheral blood PMN before or five days after antibiotic use. There was statistically non-significant difference in ascitic fluid PMN, serum and ascitic fluid hs-CRP before treatment while the difference is significant between both groups regarding them five days after treatment. Percent change in serum hs-CRP was equal to that of ascitic fluid PMN. Percent change in ascitic fluid hs-CRP was comparable to that of ascitic fluid PMN. Conclusion: Serum and ascitic fluid hs-CRP level can be considered as alternative prognostic markers in cirrhotic patients with SBP