value of granulocyte elastase versus ascitic fluid polymorphnuclear cell count in diagnosis of spontaneous bacterial peritonitis

ABSTRACT

Spontaneous bacterial peritonitis [SBP] is one of the most common complications attending the onset of ascites in patients with liver cirrhosis. Granulocyte elastase [GE] is the powerful proteolytic enzyme that is released by PMNs when degranulated in infectious processes. The aim of this study was to measure GE in ascitic fluid and plasma of cirrhotic patients with SBP comparing them with the standard test in diagnosis of SBP; ascitic fluid polymorphonucleocytic count [PMN count]. Eighty five cirrhotic patients with ascites were included in the study 35 of them have SBP [ascitic PMN> 250/mm[3] and/or ascitic ascitic white blood cell count> 500/mm[3] with or without positive culture], the other 50 didn't have SBP at the time of diagnosis. GE level in the ascitic fluid and plasma was measured. Infectious group further divided into two groups according to the result of ascitic fluid culture; poitive culture spontaneous bacterial peritonitis [CP-SBP] group [contained 25 patients] and negative culture spontaneous bacterial peritonitis [CN-SBP] group [contained 10 patients]. The result showed that there was significant difference between SBP subgroups [CP-SBP and CN-SBP] in one hand and cirrhotic group without SBP in the other hand as regard the ascitic fluid WBC count [p<0.01], PMN count/mm[3] [p<0.01], and highly significant difference as regard GE micro g/ml [p<0.0001], meanwhile there was no significant difference as regard ascitic fluid protein. After treatment of the infectious group; there was statistically significant change in plasma GE [p<0.01] and highly significant difference Was recorded in ascitic fluid GE [p<0.001]. Also there was significant drop for raised serum creatinine after treatment [p<0.01]. These findings suggest that GE in the ascitic fluid is highly valuable than the ascitic fluid PMN in the diagnosis of SBP. In addition more valuable for follow up response to treatment. Lastly GE level either in plasma or ascitic fluid could be responsible for deterioration of renal function and raised creatinine level in patients with SBP