Ascitic Fluid Calprotectin as an Accurate Diagnostic Marker for Spontaneous Bacterial Peritonitis

Abstract

Background: Calprotectin is an acute-phase inflammatory protein secreted by polymorphonuclear leucocytes (PMNL). It is frequently employed in clinical practice for the diagnosis and monitoring of inflammatory bowel diseases. The objective of this work was to assess the usage of calprotectin that found in ascitic fluid as a diagnostic indicator for spontaneous bacterial peritonitis (SBP). Methods: This cross-sectional laboratory-based work was conducted on 50 individuals, diagnosed with cirrhotic-induced ascites with no laboratory or clinical findings of SBP for group 1 and diagnosed with cirrhotic-induced ascites with SBP for group 2. SBP was identified depending on a positive bacterial ascitic fluid culture, an elevated count of PMNLs in the ascites (>250 cells/mm3), and the lack of any infection originating from inside the abdomen. Results: Protein, serum ascites albumin gradient (SAAG), WBCs, PMNL, calprotectin, color of ascitic fluid, number of individuals with yellow, whitish color ascitic fluid, culture, number of patients with klebsiella, pseudomonas, E-coli, streptococcus, total leukocytic count (TLC), Alanine transaminase (ALT), International normalized ratio (INR), and C-reactive protein (CRP)had been substantially elevated in the SBP group contrasted to the group without SBP (P < 0.001). Platelets had been substantially reduced in the SBP group contrasted to non-SBP group (P-value = 0.013). The cut off point value of calprotectin 5.045 showed 89% sensitivity and 86% specificity (P-value <0.001). In multilinear regression, PMNL, and calprotectin were significant predictors of SBP (P ≤ 0.05). Conclusions: The levels of ascitic calprotectin were markedly raised in the group with SBP contrasted to the group without SBP. Furthermore, there was a strong association between ascitic calprotectin levels and the established diagnostic criterion for SBP, which is the presence of PMNLs of 250 cells/mm3 or higher. Consequently, it may serve as a dependable and satisfactory diagnostic indicator for accurately identifying SBP. Furthermore, there is a direct correlation between the amount of ascitic calprotectin and the severity of liver damage.