High sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites.
OBJECTIVE
Diagnosis of spontaneous bacterial peritonitis in cirrhotic ascites is based on a polymorphonuclear leukocyte count of ascitic fluid equal or greater than 250/mm3 in the presence of clinical signs. There is a small number of patients with positive ascitic fluid culture whose polymorphonuclear leukocyte count is less than 250/mm3. In this study, we assessed the diagnostic value of serum high sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites.


METHODS
Patients with decompensated cirrhosis were enrolled in three groups. Group 1: Signs and symptoms of peritonitis plus a polymorphonuclear leukocyte count of ascitic fluid equal or greater than 250/mm3. Group 2: Signs and symptoms of peritonitis, but polymorphonuclear leukocyte count of ascitic fluid less than 250/mm3. Group 3: No signs and symptoms of peritonitis and polymorphonuclear leukocyte count of ascitic fluid less than 250/mm3. Ceftriaxone was started in Groups 1 and 2. Serum level of hsCRP was repeated after the 2nd day of the antibacterial treatment.


RESULTS
Mean levels of serum hsCRP were 68.4 mg/dl, 68.3 mg/dl and 6.5 mg/dl in Groups 1, 2 and 3 respectively. Those levels were significantly higher in Groups 1 and 2 compared to Group 3 (p < 0.0001). After the 2nd day of ceftriaxone, serum hsCRP decreased to a mean level of 9.0 mg/dl in Group 1 and to 9.1 mg/dl in Group 2.


CONCLUSIONS
These findings indicate that elevated hsCRP levels may discriminate patients with and without spontaneous bacterial peritonitis even in the presence of nonneutrocytic ascites, and may have utility in the assessment of treatment response.
Guler
Kerim
K
Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University.
Vatansever
Sezai
S
Kayacan
Seyit Mehmet
SM
Salmayenli
Nihal
N
Akkaya
Vakur
V
Erk
Osman
O
Palanduz
Ayse
A
D001202:Ascitic Fluid / Q000166:cytology*; D001424:Bacterial Infections / Q000097:blood* / Q000150:complications / Q000382:microbiology; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D010538:Peritonitis / Q000097:blood* / Q000150:complications / Q000382:microbiology; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D015415:Biomarkers; D002097:C-Reactive Protein