Study On The Diagnostic Value Of CRP,D-D And NLR In Cirrhosis With Spontaneous Bacterial Peritonitis

Objective: To explore the diagnostic value of C-reactive protein(CRP),D-dimer(D-D)and neutrophil to lymphocyte ratio(NLR)in liver cirrhosis with spontaneous bacterial peritonitis(SBP),in order to provide some clues for the early diagnosis of SBP.Methods: Select patients who were hospitalized in the Affiliated Hospital of Inner Mongolia Medical University from June 2017 to June 2022 and were definitely diagnosed as liver cirrhosis with ascites.Collect general and clinical date of all patients.The former includes gender,age,causes of disease,Child-Pugh grade,past history and complications;The latter includes CRP,blood routine examination,liver and kidney function,blood coagulation function,and calculate the NLR.All patients were divided into SBP group and non-SBP group according to whether they were combined with SBP.Using SPSS 22.0 to analyze two sets of data,and the difference was considered statistically significant at P<0.05.Results:(1)A total of 250 patients were enrolled through strict inclusion and exclusion criteria,including 164 males(65.6%)and 86 females(34.4%),with an average age of 56.3 ±12.21 years.In terms of etiology,98 cases(39.2%)were caused by virus,72 cases(28.8%)by Alcoholic hepatitis,61 cases(24.4%)by autoimmune liver disease and 19 cases(7.6%)by other causes.In terms of complications,the most common complication was SBP(44%),followed by gastrointestinal bleeding encephalopathy(24.4%),hepatic encephalopathy(14.4%)and Hepatorenal syndrome encephalopathy(4%).(2)The subjects were divided into 110 SBP patients and 140 non-SBP patients.The proportion of Child-Pugh grade between the two groups was statistically significant(P<0.05).In the SBP group,the proportion of patients with grade C was the highest(52.7%),followed by grade B(40.0%),and grade A(7.3%);In the non-SBP group,the proportion of patients with grade B was the highest(44.3%),followed by grade C(33.6%)and grade A(22.1%).There was no significant difference in age,gender,etiology,past history,and complications between the two groups(P>0.05).(3)There were significant differences in WBC,HB,Alb,Tbil,SCR,PT,INR,APTT,PTA,CRP,D-D,NLR between the two groups(P<0.05).Binary logistic regression analysis shows that: CRP(OR=1.098,95%CI:1.061~1.140,P<0.001),D-D(OR=1.104,95%CI:1.006~ 1.211,P=0.036),and NLR(OR=1.150,95% CI: 1.035~1.277,P=0.009)were independent risk factors for the occurrence of SBP.After treatment,the levels of CRP,D-D,and NLR in the SBP group were significantly lower than before treatment(P<0.001).(4)According to Receiver operator characteristic curve(ROC)analysis,among the individual indicators,CRP has the highest diagnostic value for SBP,with area under the curve(AUC)of 0.844,followed by NLR and D-D,with AUC of 0.762 and 0.688,respectively.In the combination of the two indicators,the diagnostic value of CRP+D-D and CRP+NLR is higher,with AUC of 0.850 and 0856,respectively.The combined detection of the three indicators had the highest AUC,which was 0.863.The diagnostic value was improved,and the difference was statistically significant(P<0.001).Conclusion:(1)CRP,D-D and NLR are independent risk factors for cirrhosis complicated with SBP.(2)CRP,D-D and NLR have certain clinical diagnostic value in patients with cirrhosis and SBP,and CRP has the highest diagnostic efficacy of SBP.(3)The combined detection of the two or the three has higher sensitivity and specificity than the single index,which can provide clues for early diagnosis of SBP.