The Diagnostic and Prognostic Values of C-Reactive Protein and Procalcitonin during Bacterial Infections in Decompensated Cirrhosis.

BACKGROUND: Bacterial infection (BI) represents the main cause of decompensation and death in cirrhotic patients. Procalcitonin (PCT) and C-reactive protein (CRP) are two widely used biomarkers that may be helpful for early detection of BI especially in the presence of inflammation. Their accuracy for the diagnosis of BI in patients with chronic liver disease has been a subject of debate. In this study, we aimed to learn whether PCT and CRP would be helpful as early markers of BI in patients with cirrhosis and to evaluate their prognostic value in terms of mortality. SUBJECTS AND METHODS: We retrospectively included 92 adult patients with decompensated cirrhosis. PCT and CRP plasma levels were obtained within the first 24 hours of admission. Their diagnostic and prognostic values were compared using the appropriate statistical analysis. RESULTS: Ninety-two patients were included. BI was diagnosed in 60 patients (65%). Mean white blood cell (WBC) count (p = 0.005) and PCT and CRP serum levels (p < 0.001) were higher in the BI group than in the non-BI (NBI) group. The diagnostic accuracy of CRP and PCT for the diagnosis of BI was better than that of WBC. CRP was the most sensitive marker (70%) while PCT was the more specific (96.6%). No one of those biomarkers was predictive of 3-month mortality in patients with BI. CONCLUSION: Regarding BI in patients with decompensated cirrhosis, CRP maintains efficiency slightly higher than that of the PCT without being discriminative. However, no prognostic value has been established for these markers.

Hepatic hydrothorax: About a hospital serie of 63 cases.

BACKGROUND: Hepatic hydrothorax is a less common complication of cirrhosis with an estimated prevalence of 10- 15%. In the vast majority of cases, ascites are also present but significant pleural effusion may develop in patients without ascites. Hepatic hydrothorax is associated with cirrhosis whatever its etiology. The prognosis of hepatic hydrothorax remains unclear and is closely related to available therapeutic options. The aim of our study is to determine the prevalence of hydrothorax in cirrhotic patients, detail its clinical and therapeutic characteristics, and study the evolutive profile of cirrhotic patients with hydrothorax by comparing it to those without hydrothorax. We also search predictive factors of development of this complication in cirrhotic patients. METHODS: We conduct a retrospective and case-control study including 63 cirrhotic patients with hepatic hydrothorax hospitalized in gastroenterology department of Charles Nicolle hospital of Tunis, during a period of fiveteen years, from January 2000 to January 2015. RESULTS: The prevalence of hydrothorax was 14.5%. The mean age was 62 ± 14 years (range, 22- 86 years). The sex ratio H/F was 1.52. Hepatic hydrothorax was symptomatic in 35 patients. It was right-sided in 60%, left-sided in 24% and bilateral in 16% of cases. Hydrothorax was on average size abundance in 54% of cases. It was transsudatif in 52.5% of cases. Hepatitis C was the most frequent cause of cirrhosis (54%). Our results show that hepatic hydrothorax was present with important ascites in 35 patients. Hydrothorax was significantly related to Child-Pugh C severity of cirrhosis (p=0.0001). Hydrothorax occurence was significantly associated with a low level of albumin (p=0.001), an important hyponatremia (p=0.001) and a low prothrombin rate (p=0.02). A therapeutic thoracentesis was performed in 57% of cases. Diuretics based on spironolactone and furosemide were indicated in 30 patients. Evolution was favorable in 19 patients. Refractory hepatic hydrothorax was present in 31 patients. Death, in the days which follow the hospitalisation, was in 13 patients. The 5-years survival rate was 60%. The mean survival time of patients with hepatic hydrothorax was 8.41 years against 10.75 years at patients without hepatic hydrothorax. CONCLUSION: Hepatic hydrothorax is a common complication in our study. The improvement of the prognosis of our patients would require a better therapeutic management and especially the possibility of orthotopic liver transplantation which is the optimal therapeutic option for patients with hepatic hydrothorax.

Metals bioaccumulation and histopathological biomarkers in Carcinus maenas crab from Bizerta lagoon, Tunisia.

Metals concentrations and histolopathological lesions of gills and digestive gland were investigated in Carcinus maenas crabs sampled from Bizerta Lagoon and Kuriat Island (Tunisia) as control site. The concentrations of trace metals varied between tissues, sites and sampling time. The highest levels of the analysed metals in gills and digestive gland were noted in Menzel Bourguiba and Cimentery sites at both sampling times (February and July). The higher metals loads were associated with severe and various tissues alterations in contaminated crabs. We particularly noted in the gills a haemocytic infiltration, distension and enlargement of the lamellae, lifting of lamellar epithelium, necrotic lesions and fusion of lamellae in the most polluted sites (Menzel Bourguiba and Cimentery). Moreover, others pathological alterations were observed in digestive gland of crabs collected from polluted sites and with a severity site dependent. We observed necrotic tubules containing tissue debris in the lumen with more intensity in crabs collected from Cimentery site in both sampling times. The thickened basal laminae and the walling off of the tubules by haemocytes around the thickened basal laminae were more abundant at Menzel Bourguiba than at others sites. The coagulation in the thickened basal laminae was observed only at Cimentery in February. Tissues histopathological lesions were sensitive to discriminate crabs of different sites and demonstrated its usefulness in this biomonitoring study. We recommend the association of histopatholocial lesions to biochemical biomarkers in future biomonitoring studies.

Biochemical effects in crabs (Carcinus maenas) and contamination levels in the Bizerta Lagoon: an integrated approach in biomonitoring of marine complex pollution.

The biochemical effects in Carcinus maenas and contamination levels in seawater and sediments of Bizerta Lagoon (northeast of Tunisia) were investigated. The levels of metals and hydrocarbons were higher in seawater and sediments in Menzel Bourguiba and Cimentery in February and July than in the other sampling sites. Differences among sites for glutathione S-transferase, catalase, acetylcholinesterase activities, and the content of lipid peroxidation and metallothioneins in two important organs which accumulated contaminants (the gills and the digestive gland) of the C. maenas were found and possibly related to differences in metal and hydrocarbon levels. The seasonal variation of biomarkers was possibly associated with chemical contamination and also with the high fluctuation of physico-chemical characteristics of the sites. The integrated biomarker response values found in the five sites is in good agreement with hydrocarbon and trace metal concentrations detected in the water and sediments of the stressful places where crabs are living.

Multiple biomarkers of pollution effects in Solea solea fish on the Tunisia coastline.

This field study investigates the morphological indices (condition index, hepatosomatic index) and biochemical (catalase (CAT), glutathione S-transferase (GST), acetylcholinesterase (AChE), metallothionein (MT), lipid peroxidation) parameters in liver, gills and kidney of common sole (Solea solea) originating from different sites of the Tunisian coast area impacted by different anthropogenic activities. Differences among sites and tissues for AChE, GST, CAT, MT and TBARS were found and possibly related to known sources of domestic and industrial discharges in the studied sites. Liver, gills and kidney CAT, liver and kidney MT and brain AChE were key biomarkers to discriminate fish of different sites. So, we suggest using these biomarkers in future biomonitoring.

Biochemical responses and metals levels in Ruditapes decussatus after exposure to treated municipal effluents.

This study assessed the responses of biochemical biomarkers and metals levels in Ruditapes decussatus exposed to the increasing concentrations of treated municipal effluents (TME) discharged into the Tunisian coastal area. Clams were exposed to 0%, 1%, 3% and 10% for 7 and 14 day and the following biochemical responses were measured: (1) catalase activity and lipid peroxidation levels (TBARS) as oxidative stress biomarkers, (2) gluthathione S-transferase (GST) activity as a phase II conjugation enzyme; (3) cholinesterase activity (ChE) as biomarker of neurotoxicity, and (4) metallothioneins as a proteins highly induced by heavy metals. A significant uptake of Cu, Cd and Zn in digestive gland and serious biochemical alterations were observed. Thus, exposure of clams to croissant concentration of TME have the potential to increase the oxidative stress biomarkers (TBARS, CAT activity) and MT levels; and decrease ChE activity in both gills and digestive gland. Current experimental results suggest that CAT, GST, ChE activities and MT and TBARs levels in gills and digestive gland of clam R. decussatus are sensitive and suitable responses for assessing the effects of anthropogenic contaminants on the aquatic ecosystems, particularly effluent complex mixtures.

Integrated assessment of biochemical responses in Mediterranean crab (Carcinus maenas) collected from Monastir Bay, Tunisia.

The biochemical response of Mediteranean Crab (Carcinus maenas) collected at five stations of Monastir Bay and from Kuriat station as control was studied using a set of complementary biomarkers. The catalase, glutathione S-transferase, lactate dehydrogenase, acetycholinesterase activities; and metallothionein and malonediladehyde levels in gills were evaluated. Results revealed differences among sites in relation to each specific biomarker. Hence, a suite of biomarkers can be used to discriminate sampling sites according to types of pollution, reflecting differing conditions of anthropogenic impact. Based on Integrated Biomarker Response, the highest values and critical biochemical alteration were observed at Khniss and Ksibat in response to urban and industrial discharges and the lowest IBR value was found at reference site. The current study has shown clearly that a biomarker-based index is usefulness tool in the monitoring Tunisian coast using C. maenas as sentinel specie. Further studies in progress to investigate the seasonal variations of IBR levels and its relationship to pollutants concentrations in the sediment, gills and digestive gland of Carcinus maenas from Monastir Bay.