A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites.
OBJECTIVE
Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites.


METHODS
In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay.


RESULTS
Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.08 (3.62-6.58) vs. 1.82 (0.64-3.86) ng/ml; P < 0.001 and 12.7 (8.55-17.05) vs. 5.94 (2.57-10.64) ng/ml; P < 0.001], respectively. Ascitic and serum VEGF were significantly increased in malignant ascites than benign ascites patients [0.68 (0.39-0.96) vs. 0.41 (0.25-0.83) ng/ml; P < 0.001 and 0.74 (0.41-1.08) vs. 0.54 (0.23-0.86) ng/ml; P < 0.001], respectively. At a cutoff value of 7.3 and 0.63 ng/ml, serum CRP and VEGF had specificity (77.3 and 89.5 %) and sensitivity (83.1 and 94.9 %) for detecting malignant ascites [area under the curve (AUC) 0.821, 0.921], respectively. At a cutoff value of 2.5 and 0.57 ng/ml, ascitic CRP and VEGF had specificity (81.6 and 85.5 %) and sensitivity (84.7 and 91.5 %) for detecting malignant ascites (AUC 0.842, 0.894), respectively.


CONCLUSIONS
Elevated ascitic fluid and serum CRP and VEGF values were related to the malignant ascites.
Tropical Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, 35516, Egypt. Ahmedabdelrazik76@gmail.com.
Ahmed
A
Abdel-Razik
Tropical Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, 35516, Egypt.
Nasser
N
Mousa
Tropical Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, 35516, Egypt.
Hatem
H
Elalfy
Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Tarek Fouad
TF
Sheta
Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Mahmoud
M
Awad
Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Mostafa
M
Abdelsalam
Clinical Pathology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Rania
R
Elhelaly
Clinical Pathology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Rasha
R
Elzehery
Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Nawal S
NS
Gouda
Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt.
Waleed
W
Eldars
D001201:Ascites / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D002097:C-Reactive Protein
C-reactive protein; Malignant ascites; Vascular endothelial growth factor