Elevated C-reactive protein and spontaneous bacterial peritonitis in children with chronic liver disease and ascites.
OBJECTIVE
The aims of this study were to compare laboratory indices of spontaneous bacterial peritonitis (SBP) and noninfected ascites in children with chronic liver disease and to determine the infectious agents involved in SBP.


METHODS
The medical records of 90 children with chronic liver disease and ascites studied between January 2005 and August 2011 were reviewed for laboratory data of diagnostic significance in SBP. Standard laboratory tests included blood cell count, coagulation indices, liver and renal function tests, C-reactive protein (CRP), serum sodium concentration, serum albumin, and serum cultures. Ascitic fluid obtained from 152 paracentesis procedures was assayed for cytology, Gram stains, neutrophil counts, and bacteriological cultures.


RESULTS
The SBP group manifested significantly lower albumin levels and elevated CRP levels, prothrombin times, international normalized ratios, and leukocyte number (P<0.05 in each case). CRP was shown to be an independent variable in the prediction of SBP. Values of serum creatinine, sodium concentration, urea, total bilirubin and differential leukocyte shift were comparable in SBP and noninfected ascites. Streptococcus pneumoniae was the most prevalent infectious agent in the ascitic fluid (44%).


CONCLUSIONS
CRP may be useful in early detection and monitoring of SBP in children with liver disease.
*Department of Pediatric Emergency †Department of Pediatric Hepatology ‡Department of Pediatric Emergency Department, Children's Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Marcela
M
Preto-Zamperlini
Sylvia Costa Lima
SC
Farhat
Maria Beatriz Moliterno
MB
Perondi
Adriana Pozzi
AP
Pestana
Patricia Salles
PS
Cunha
Renata Pereira Sustovich
RP
Pugliese
Cláudio
C
Schvartsman
D000293:Adolescent; D001201:Ascites / Q000378:metabolism* / Q000382:microbiology; D001202:Ascitic Fluid / Q000382:microbiology*; D001424:Bacterial Infections / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000473:pathology; D008297:Male; D019152:Paracentesis; D010538:Peritonitis / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology; D011517:Prothrombin Time; D012709:Serum Albumin / Q000378:metabolism; D013296:Streptococcus pneumoniae
D012709:Serum Albumin; D002097:C-Reactive Protein