title: Procalcitonin and macrophage inflammatory protein-1 beta (MIP-1β) in serum and peritoneal fluid of patients with decompensated cirrhosis and spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  Spontaneous bacterial peritonitis (SBP) is the most frequent infection in patients with cirrhosis causing significant mortality which requires rapid recognition for effective antibiotic therapy, whereas ascitic fluid cultures are frequently negative. The aim of this study was to evaluate the SBP diagnostic efficacy of procalcitonin (PCT) and macrophage inflammatory protein-1 beta (MIP-1β) measured in serum and peritoneal fluid.
  
  
  METHODS
  Thirty-two participants with liver cirrhosis and ascites were included into the study (11 females and 21 males, mean age 49.5 ± 11.9 years). The peritoneal fluid and venous blood were collected for routine laboratory examinations and measurements of PCT and MIP-1β. Patients were divided into two groups according to the ascitic absolute polymorphonuclear leukocytes count (≥250 mm(-3) and <250 mm(-3)).
  
  
  RESULTS
  Ascites was sterile in 22 participants and SBP was diagnosed in 10 patients. Serum and ascitic levels of PCT and MIP-1β did not correlate with clinical and routine laboratory parameters. MIP-1β in the ascitic fluid was significantly higher in patients with SBP (213 ± 279 pg/ml vs. 66.3 ± 49.8 pg/ml; p=0.01). The sensitivity and specificity for diagnosis of SBP with ascitic MIP-1β were 80% and 72.7%, respectively (cut-off value 69.4 pg/ml) with AUROC 0.77 (95%CI 0.58-0.96). Serum levels of MIP-1β showed lower diagnostic yield. Serum and ascitic PCT levels were not different in patients with and without SBP.
  
  
  CONCLUSIONS
  MIP-1β concentration in ascitic fluid may distinguish patients with and without SBP with satisfactory sensitivity and specificity. Chemokines should be further explored for diagnostic use.
authors.affiliation: Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lesińska
authors.affiliation: Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland. Electronic address: mhartleb@sum.edu.pl.
authors.forename: Marek
authors.initials: M
authors.lastname: Hartleb
authors.affiliation: Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Gutkowski
authors.affiliation: Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Nowakowska-Duława
mesh_terms: D000328:Adult; D000368:Aged; D001202:Ascitic Fluid / Q000378:metabolism* / Q000382:microbiology; D001424:Bacterial Infections / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D002116:Calcitonin / Q000378:metabolism*; D015740:Calcitonin Gene-Related Peptide; D054407:Chemokine CCL4 / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D011379:Prognosis; D011498:Protein Precursors / Q000378:metabolism*; D012372:ROC Curve; D055815:Young Adult
chemical_list: C000606589:CALCA protein, human; D054407:Chemokine CCL4; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Macrophage inflammatory protein-1 beta; Procalcitonin; Spontaneous bacterial peritonitis