title: C-reactive protein and insulin-like growth factor-1 in differential diagnosis of ascites.
abstract: OBJECTIVE
  Insulin-like growth factor-1 (IGF-1) and C-reactive protein (CRP) are produced mainly by the liver; the output of these markers in response to inflammatory processes may be affected in patients with hepatic dysfunction. This may explain the differences in IGF-1 and CRP values in patients with non-portal and portal hypertension ascites. We aimed to evaluate serum and ascitic fluid IGF-1 and CRP as diagnostic markers in the differential diagnosis of benign and malignant ascites.
  
  
  METHODS
  In this prospective study, 398 consecutive patients with ascites were included. Serum and ascitic fluid levels of IGF-1 and CRP were measured using an enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Patients were divided into group 1, due to benign ascites (n = 324), and group 2, due to malignant ascites (n = 74). Serum and ascitic IGF-1 were significantly increased in malignant ascites than benign ascites group [305 ± 65.7 ng/mL vs 95 ± 53.8 ng/mL; P < 0.001 and 288 ± 54.7 ng/mL vs 83.2 ± 36.7 ng/mL; P < 0.001], respectively. Serum and ascitic CRP were significantly higher in malignant ascites than benign ascites patients [12.8 ± 6.3 mg/mL vs 6.1 ± 4.9 mg/mL; P < 0.001 and 5.1 ± 2.2 mg/mL vs 1.6 ± 1.3 mg/mL; P < 0.001], respectively. At a cutoff value of 309.4 ng/mL and 7.8 mg/mL, serum IGF-1 and CRP had (95.1%, 81%) sensitivity and (88.6%, 75.5%) specificity for detecting malignant ascites [area under the curve: 0.932, 0.845], respectively. At a cutoff value of 291.6 ng/mL and 2.6 mg/mL, ascitic IGF-1 and CRP had (94.6%, 84%) sensitivity and (83.2%, 80.3%) specificity for detecting malignant ascites (area under the curve: 0.911, 0.893) correspondingly.
  
  
  CONCLUSIONS
  Elevated serum and ascitic fluid IGF-1 and CRP levels were associated with malignant ascites.
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razik
authors.affiliation: Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Eldars
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Rania
authors.initials: R
authors.lastname: Elhelaly
authors.affiliation: Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Rasha
authors.initials: R
authors.lastname: Elzehery
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology*; D001202:Ascitic Fluid / Q000737:chemistry; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000175:diagnosis*; D011446:Prospective Studies; D012372:ROC Curve; D013048:Specimen Handling / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein
keywords: C-reactive protein; insulin-like growth factor-1; malignant ascites