title: Cirrhotic Ascites management via procalcitonin level and a new approach B-mode gray-scale histogram.
abstract: OBJECTIVE
  To determine the role of serum procalcitonin levels and ascites/subcutaneous echogenicity ratio (ASER) in predicting ascites infection in hospitalized cirrhotic patients.
  
  
  METHODS
  A total of 50 patients hospitalized because of cirrhosis-related ascites were included in this study. In these patients, 44% of ascites were infected (peritonitis), whereas 56% of ascites were sterile. These two groups were compared in terms of procalcitonin levels and ASER for predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of ASER, and the predicting outcome of ASER was compared with procalcitonin levels.
  
  
  RESULTS
  The ASER values of the patients with the diagnosis of infected ascites were significantly higher than in those with the diagnosis of sterile ascites (p<0.001). ROC analysis was performed to determine the diagnostic ASER value for infected ascites. An ASER greater than 0.0019 determined peritonitis with 95.5% sensitivity and 100% specificity. A procalcitonin level greater than 0.05 determined peritonitis with 86.4% sensitivity and 75% specificity. Using ROC analysis, an ASER greater than 0.0019 [area under curve (AUC): 0.974, 95% confidence interval (CI) (0.884-0.999, p<0.001)] was a significantly better diagnostic marker than a procalcitonin level >0.5 mg/dL [AUC: 0.860, 95% CI (0.884-0.999, p<0.001) (p<0.045)].
  
  
  CONCLUSIONS
  According to our findings, the determination of ASER and serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating ascites infections in hospitalized cirrhotic patients. ASER values significantly differentiate ascites infections better than procalcitonin levels.
authors.affiliation: Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey. ayhancekin@hotmail.com.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Şahintürk
authors.forename: Bülent
authors.initials: B
authors.lastname: Çekiç
authors.forename: Gizem
authors.initials: G
authors.lastname: Zorlu Görgülügil
authors.forename: Ferda Akbay
authors.initials: FA
authors.lastname: Harmandar
authors.forename: Seyit
authors.initials: S
authors.lastname: Uyar
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Çekin
authors.forename: Ayhan Hilmi
authors.initials: AH
authors.lastname: Çekin
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001201:Ascites / Q000097:blood* / Q000000981:diagnostic imaging / Q000382:microbiology; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006760:Hospitalization; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood / Q000000981:diagnostic imaging* / Q000382:microbiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D015203:Reproducibility of Results; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide