title: Usefulness of ascitic fluid lactoferrin levels in patients with liver cirrhosis.
abstract: BACKGROUND
  Although elevated levels of lactoferrin provide a biomarker for inflammatory bowel diseases and colorectal cancer, the clinical significance of these elevated levels in ascitic fluid of patients with ascites caused by liver cirrhosis is limited. The aims of our study were to investigate the usefulness of ascitic fluid lactoferrin levels for the diagnosis of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and to evaluate the association between lactoferrin levels and the development of hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 102 patients with ascites caused by cirrhosis were consecutively enrolled into the study, from December 2008 to December 2011. Ascitic fluid lactoferrin levels were quantified using a human lactoferrin enzyme-linked immunosorbent assay kit.
  
  
  RESULTS
  The median ascitic fluid lactoferrin levels were significantly higher in patients with SBP than in those without SBP (112.7 ng/mL vs. 0.6 ng/mL; p < 0.001). The area under the receiver operator characteristic curve for the diagnosis of SBP was 0.898 (95 % confidence interval, 0.839-0.957, p < 0.001), with a sensitivity and specificity for a cut-off level of 51.4 ng/mL of 95.8 % and 74.4 %, respectively. Moreover, the incidence of HCC in the 78 patients without SBP was significantly higher in patients with high ascitic fluid lactoferrin levels (≥35 ng/mL) than in those with low ascitic fluid lactoferrin level (<35 ng/mL).
  
  
  CONCLUSIONS
  Ascitic fluid lactoferrin level can be a useful diagnostic tool to identify SBP in patients with ascites caused by cirrhosis. Elevated ascitic fluid lactoferrin level in patients without SBP may be indicative of a developing hepatocellular carcinoma.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.|Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Jinju, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Min
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.
authors.forename: Ja Yun
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.
authors.forename: Hyun Chin
authors.initials: HC
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.|Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Jinju, Republic of Korea.
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.|Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Jinju, Republic of Korea.
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.
authors.forename: Chang Yoon
authors.initials: CY
authors.lastname: Ha
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.|Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.|Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Jinju, Republic of Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea.|Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
authors.forename: Tae Hyo
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Jin Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju, Gyeongnam, 52727, Republic of Korea. ojlee@gnu.ac.kr.|Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea. ojlee@gnu.ac.kr.
authors.forename: Ok-Jae
authors.initials: OJ
authors.lastname: Lee
mesh_terms: D019540:Area Under Curve; D001201:Ascites / Q000150:complications* / Q000473:pathology; D001202:Ascitic Fluid / Q000737:chemistry*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015415:Biomarkers / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D007781:Lactoferrin / Q000032:analysis*; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D007781:Lactoferrin
keywords: Ascites; Hepatocellular carcinoma; Lactoferrin; Liver cirrhosis; Spontaneous bacterial peritonitis