title: Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis.
abstract: OBJECTIVE
  Bacterial translocation, causing intestinal inflammation, is one of the key mechanisms in the pathogenesis of hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP) The presence of fecal calprotectin quantitatively relates to intestinal neutrophil migration and is therefore considered as a marker of intestinal inflammation. We aimed to assess the role of fecal calprotectin concentrations (FCCs) in diagnosing the onset and severity of HE and SBP.
  
  
  METHODS
  Sixty-one cirrhotics were prospectively included. Forty-two subjects served as controls. Several complications of cirrhosis were diagnosed by reference methods. Stool samples were collected for measuring FCCs. Patients revealing other causes of abnormal calprotectin results, e.g. gastrointestinal bleeding or inflammatory bowel disease were excluded. Multivariate analysis of cirrhosis-associated complications and their relation to FCCs was performed.
  
  
  RESULTS
  Fecal calprotectin concentrations were higher in cirrhotics compared with controls (P<0.001). Among cirrhotics, FCCs were elevated dependent on the severity of liver disease as assessed by Child- and model for end-stage liver disease-scores. The corresponding correlation co-efficients by Spearman's were 0.577 (P<0.001) and 0.303 (P=0.018) respectively. A correlation emerged between elevated FCCs and HE grading as measured by West-Haven criteria and critical flicker frequency (both P<0.001; sensitivity=0.94 and 0.93, specificity=0.95 and 0.89 respectively) and SBP (P<0.02; sensitivity=0.71, specificity=0.79). FCCs were higher in cirrhotic subjects with additional extra-intestinal inflammation (P<0.01; sensitivity=0.65, specificity=0.8). The Pearsons correlation coefficients were 0.190 and 0.164 revealing no influence (P=0.142 and P=0.207) of laboratory parameters of systemic inflammation on FCCs in cirrhotic subgroup.
  
  
  CONCLUSIONS
  Fecal calprotectin concentrations serve as a screening tool for HE and SBP. Assessment of FCCs may faciliate grading of HE-severity.
authors.affiliation: Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany. gastroenterologie@kh-bogenhausen.de
authors.forename: Felix
authors.initials: F
authors.lastname: Gundling
authors.forename: Fabian
authors.initials: F
authors.lastname: Schmidtler
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schulte
authors.forename: Thomas
authors.initials: T
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Pehl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schepp
authors.forename: Holger
authors.initials: H
authors.lastname: Seidl
mesh_terms: D000368:Aged; D018988:Bacterial Translocation; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D005243:Feces / Q000737:chemistry; D005260:Female; D005858:Germany; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000382:microbiology; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex