title: Granulocyte elastase in cirrhotic patients with spontaneous bacterial peritonitis.
abstract: Granulocyte elastase (GE) is a powerful proteolytic enzyme that is released by PMNs when degranulated in infectious processes. The aim of this study was to measure GE in ascites and plasma of cirrhotic patients with spontaneous bacterial peritonitis (SBP). We studied 29 cirrhotic patients, 17 of them having SBP (group A). Twelve patients with noninfected ascites formed the control group (group B). At the time of diagnosis of SBP, GE levels in ascites (183.17 +/- 86.11 microg/liter) and plasma (114.6 +/- 35.99 microg/liter) were higher in group A than in group B (27.41 +/- 11.54 microg/liter, P < 0.00001 and 82.54 +/- 20.52 microg/liter, P = 0.01, respectively). Levels of GE in ascites had a high value for discriminating between patients with and without SBP. In the patients who responded to the initial antibiotic treatment, these values significantly decreased in ascites (67.69 +/- 54.22 microg/liter, P = 0.003) and plasma (67 +/- 22.39 microg/liter, P = 0.01) 48 hr after therapy was started, in parallel with the decrease of PMN in ascites. In patients who did not respond, the production of GE remained elevated. Patients who developed renal insufficiency following SBP had more marked elevation of GE in plasma (144.8 +/- 33.43 microg/liter) than those with normal renal function (99.5 +/- 27.53 microg/liter, P = 0.02). These results suggest that the measurement of GE may be helpful for the diagnosis of SBP in patients with cirrhosis and for assessing the efficacy of therapy. In addition, the release of GE into plasma may contribute to the impairment of renal function that follows SBP in some patients.
authors.affiliation: Department of Hepatogastroenterology, University Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Casafont
authors.forename: M
authors.initials: M
authors.lastname: Rivero
authors.forename: M D
authors.initials: MD
authors.lastname: Fernandez
authors.forename: J
authors.initials: J
authors.lastname: Crespo
authors.forename: E
authors.initials: E
authors.lastname: Fabrega
authors.forename: E
authors.initials: E
authors.lastname: Sánchez
authors.forename: F
authors.initials: F
authors.lastname: Pons-Romero
mesh_terms: D001201:Ascites / Q000175:diagnosis / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D016022:Case-Control Studies; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D019272:Leukocyte Elastase / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D019272:Leukocyte Elastase