ASCITIC INTERLEUKIN 6 AND SERUM PROCALCITONIN FOR EARLY DETECTION OF SPONTANEOUS BACTERIAL PERITONITIS IN ADVANCED LIVER CIRRHOSIS

  • Marwa Ibrahim Metawea Department Hepatology, Faculty of Medicine, Alexandria University
  • Doaa Ahmed Elwazzan Department Tropical Medicine, Faculty of Medicine, Alexandria University
  • Reham Abdel Haleem Abo Elwafa Department Clinical Pathology, Faculty of Medicine, Alexandria University
  • Sara Lotfy Asser Department Microbiology, Faculty of Medicine, Alexandria University
Keywords: Spontaneous bacterial peritonitis (SBP), inflammatory markers, IL 6, highly sensitive C-reactive protein and procalcitonin�

Abstract

Background: Liver cirrhosis is associated with frequent bacterial
infections that increase mortality. Spontaneous bacterial peritonitis (SBP)
is an important cause of mortality and morbidity in such patients with
ascites. A polymorphonuclear (PMN) cell count >250/μl in the ascitic
fluid is the current gold standard for diagnosing SBP which is considered
a subjective test. Early diagnosis of SBP although vital is difficult in these
patients. Interleukin 6 is pro-inflammatory marker that increases earlier in
bacterial infection than other inflammatory markers. This is crucial in
cirrhotic patients to initiate treatment accordingly.
Objective: Evaluate the role of IL 6 together with other inflammatory
markers in early diagnosis of SBP and as prognostic markers as well.
Patients and methods: The study was conducted on 60 cirrhotic patients
with ascites divided into 2 groups. Group I included 30 cirrhotic patients
with sterile ascites and group II, 30 patients with SBP. Liver profile,
serum creatinine, serum sodium, ascitic IL6 , C-reactive protein, serum
pro-calcitonin , and ascitic fluid analysis were done for all patients in both
groups. Exclusion criteria included; acute infection, diabetes mellitus,
coronary vascular disease, collagen vascular disease and any form of
sepsis.
Results: Ascitic IL6 mean value was 2171.5(62.2 – 5000) and 342.5(146
– 2567) pg/ml in groups I and II respectively which was significantly
higher in group I than among group II patients (P<0.001). Furthermore,
the mean s. procalcitonin was 0.8(0.4-1.1) and 0.4(0.04-0.7) ng/ml among
groups In and II respectively and it was significantly higher among the
patients with SBP (P<0.001). Diagnosis of SBP among patients with liver
cirrhosis could be suggested when ascitic IL6 and serum procalcitonin are
assessed at a cut-off values of >780 pg/ml and >0.4ng/ml respectively.
Conclusion: Ascitic IL6 and serum procalcitonin can be used as a
valuable surrogate serum marker for early diagnosis of SBP in cirrhotic
patients.

Published
2019-12-01
Section
Articles