title: Ascitic Calprotectin is a Novel and Accurate Marker for Spontaneous Bacterial Peritonitis.
abstract: BACKGROUND
  Spontaneous bacterial peritonitis (SBP) is a known complication of advanced cirrhosis and presents a high mortality rate. A polymorphonuclear (PMN) cell count >250/μl in the ascitic fluid is the current gold standard for diagnosing SBP.
  
  
  OBJECTIVE
  We evaluated the accuracy of a point-of-care test (POCT) for ascitic calprotectin in diagnosing patients with SBP.
  
  
  METHODS
  Eighty-eight patients admitted with decompensation of liver cirrhosis were studied including 41 patients (46.6%) with SBP. Ascitic calprotectin was measured using a quantitative POCT developed by Bühlmann®.
  
  
  RESULTS
  Calprotectin levels correlated with PMN cell count and other inflammatory markers and were significantly higher in patients with SBP. An optimal cutoff of calprotectin above 1.57 μg/ml presented high sensitivity (87.8%), specificity (97.9%), and positive (97.3%) and negative (90.2%) predictive values for diagnosing SBP. Using calprotectin selectively in patients with a serum albumin-ascites gradient above 11 g/l further increased the sensitivity and negative predictive values of the test.
  
  
  CONCLUSIONS
  Ascitic calprotectin appears to be a reliable method for diagnosing SBP in patients with liver cirrhosis. It may present an alternative to other conventional diagnostic methods.
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal. Samuelrmfernandes@gmail.com.
authors.forename: Samuel Raimundo
authors.initials: SR
authors.lastname: Fernandes
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Santos
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Narcisa
authors.initials: N
authors.lastname: Fatela
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Cilénia
authors.initials: C
authors.lastname: Baldaia
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Tato Marinho
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Proença
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramalho
authors.affiliation: Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Velosa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000378:metabolism*; D001424:Bacterial Infections / Q000150:complications*; D015415:Biomarkers; D005260:Female; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology* / Q000382:microbiology*; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
keywords: ascites; liver cirrhosis; spontaneous bacterial peritonitis