A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections
Abstract Background The accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measure...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-03-01
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| Series: | Egyptian Liver Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s43066-020-0021-8 |
| _version_ | 1818901805198737408 |
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| author | Hany M. Elsadek Soha A. Elhawari Ahmed Mokhtar |
| author_facet | Hany M. Elsadek Soha A. Elhawari Ahmed Mokhtar |
| author_sort | Hany M. Elsadek |
| collection | DOAJ |
| description | Abstract Background The accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measurement of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which we called the PEC index. This cross-sectional analytic study comprised 178 cirrhotic patients with ascites (60 patients with SBP and 118 patients with sterile ascites), after excluding non-SBP infection, during the period from March 2019 until September 2019. In all participants, serum levels of PCT, ESR, and CRP were measured, and PEC index was calculated [PEC index = PCT × (ESR + CRP)]. Results Patients with SBP (n = 60) had significantly higher serum PEC index than those with sterile ascites (n = 118) (41.0/31.2–93.0 vs. 9.9/5.9–15.0, P < 0.001). PEC index distinguished culture positive cases significantly (P < 0.001). Using receiver operating characteristic (ROC) statistics, the sensitivity and specificity of PCT, at a cutoff value of 0.590 ng/mL, for SBP diagnosis, were 81.67% and 93.33%, respectively (area under the curve [AUC] = 0.879; 95% confidence interval [CI] 0.809–0.948). The sensitivity and specificity of ESR, at a cutoff value of 27.0 mm/hour, were 73.33% and 61.67%, respectively (AUC = 0.679; 95% CI 0.581–0.776). The sensitivity and specificity of CRP, at a cutoff value of 21.0 mg/L, were 93.33% and 51.67%, respectively (AUC = 0.736; 95% CI 0.639–0.833). While, the sensitivity and specificity of PEC index, at a cutoff value of 20, were highest (98.33% and 96.67%, respectively, AUC = 0.977; 95% CI 0.940–0.996). Conclusion Serum PEC index makes an accurate noninvasive diagnosis of SBP, after excluding other infections. |
| first_indexed | 2024-12-19T20:25:35Z |
| format | Article |
| id | doaj.art-70534f5b74534439aa5e1e91b6ddbceb |
| institution | Directory Open Access Journal |
| issn | 2090-6226 |
| language | English |
| last_indexed | 2024-12-19T20:25:35Z |
| publishDate | 2020-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Liver Journal |
| spelling | doaj.art-70534f5b74534439aa5e1e91b6ddbceb2022-12-21T20:06:51ZengSpringerOpenEgyptian Liver Journal2090-62262020-03-011011810.1186/s43066-020-0021-8A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infectionsHany M. Elsadek0Soha A. Elhawari1Ahmed Mokhtar2Gastroenterology & Hepatology Unit, Internal Medicine Department, Faculty of Medicine, Zagazig UniversityTropical Medicine Department, Faculty of Medicine, Zagazig UniversityClinical Pathology Department, Faculty of Medicine, Zagazig UniversityAbstract Background The accurate non-invasive diagnosis of spontaneous bacterial peritonitis (SBP) in patients with decompensated liver cirrhosis has not been achieved yet. The aim of the study was to obtain an unmistakable diagnosis of SBP using a new simple serum bioscore, made by combined measurement of procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which we called the PEC index. This cross-sectional analytic study comprised 178 cirrhotic patients with ascites (60 patients with SBP and 118 patients with sterile ascites), after excluding non-SBP infection, during the period from March 2019 until September 2019. In all participants, serum levels of PCT, ESR, and CRP were measured, and PEC index was calculated [PEC index = PCT × (ESR + CRP)]. Results Patients with SBP (n = 60) had significantly higher serum PEC index than those with sterile ascites (n = 118) (41.0/31.2–93.0 vs. 9.9/5.9–15.0, P < 0.001). PEC index distinguished culture positive cases significantly (P < 0.001). Using receiver operating characteristic (ROC) statistics, the sensitivity and specificity of PCT, at a cutoff value of 0.590 ng/mL, for SBP diagnosis, were 81.67% and 93.33%, respectively (area under the curve [AUC] = 0.879; 95% confidence interval [CI] 0.809–0.948). The sensitivity and specificity of ESR, at a cutoff value of 27.0 mm/hour, were 73.33% and 61.67%, respectively (AUC = 0.679; 95% CI 0.581–0.776). The sensitivity and specificity of CRP, at a cutoff value of 21.0 mg/L, were 93.33% and 51.67%, respectively (AUC = 0.736; 95% CI 0.639–0.833). While, the sensitivity and specificity of PEC index, at a cutoff value of 20, were highest (98.33% and 96.67%, respectively, AUC = 0.977; 95% CI 0.940–0.996). Conclusion Serum PEC index makes an accurate noninvasive diagnosis of SBP, after excluding other infections.http://link.springer.com/article/10.1186/s43066-020-0021-8CirrhosisSpontaneous bacterial peritonitisProcalcitoninPEC index |
| spellingShingle | Hany M. Elsadek Soha A. Elhawari Ahmed Mokhtar A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections Egyptian Liver Journal Cirrhosis Spontaneous bacterial peritonitis Procalcitonin PEC index |
| title | A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| title_full | A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| title_fullStr | A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| title_full_unstemmed | A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| title_short | A novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| title_sort | novel serum index for accurate diagnosis of spontaneous bacterial peritonitis in cirrhotic patients without other infections |
| topic | Cirrhosis Spontaneous bacterial peritonitis Procalcitonin PEC index |
| url | http://link.springer.com/article/10.1186/s43066-020-0021-8 |
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