| Objective: To explore the clinical value of serum procalcitonin(PCT)assay for prediciting spontaneous bacterial peritonitis (SBP) in end-stageliver diseases patients,providing evidence for early diagnosis of SBP andimproving the curative and survival rate in SBP patients through early useof antibiotics,then shortening their hospitalization days.Methods: The patients who had underwent the examination of serumPCT in our department were collected from March2011to June2013.Their ascitic routine test, serum PCT, complete blood count, et al. werecollected in detail, and comparing the PCT concentration of the two groups’patients before receiving antibiotic treatment,and also the serum PCT valuein the effective antibiotic treatment patients of the SBP group pre-and-postantimicrobial treatment were compared. ROC curve was drawn to get theoptimum cut-off value of serum PCT to diagnose SBP with the bestsensitivity and specificity.To calculate the sensitivity (SE), specificity (SP),positive predictive value (PPV), negative predictive value (NPV), positivelikelihood ratio (PLR) and negative likelihood ratio (NLR)of serum PCTwhen compared with the presented criterion to diagnose SBP.Logistic regression was made with the SBP existed or not as the binary variable,thenpossible risky factors,like age, gender, albumin, hospitalization days,prothrombin time activity, total bilirubin, procalcitonin, abdominal pain andtenderness, neutrophilic granulate percentage, gastrointestinal tracthemorrhage, hepatorenal syndrome,hepatic encephalopathy, hyponatremiaand diabetes were brought into this equation to realize the risky factors ofSBP in end-stage liver diseases.Results: A total of362hospitalization patients were included in thisstudy,,then they were divided into SBP group(n=178) and non-SBPgroup(n=184).The bacteria culture positive rate of ascites was only4.6%in SBP group. The median value of serum PCT were0.73ng/ml and0.15ng/ml before antibiotic treatment in SBP group and non-SBP group, therewere significantly differences by U test(Z=-11.9, U=0.000).13SBPpatients with blood positve bacteria culture had highest serum PCT with themedian value of1.73ng/ml, which was higher than that in SBP group. Forsome effective antibiotic therapy patients,the median values of serum PCTwere0.40ng/ml (n=46),0.32ng/ml(n=19)and0.33ng/ml (n=25) at3,5and7days respectively after effective antibiotics treatment, which weredecreased obviously compared with their median values of0.86ng/ml，0.72ng/ml and0.79ng/ml before treatment. By ROC analysis, a serum PCTvalue of more than0.462ng/ml was used to diagnose SBP with sensitivityof83.7%, and specificity94.9%(AUC=0.95,95%CI:0.93~0.97, p=0.00) in end-stage liver diseases patients.The SE, SP, PPV, NPV, PLR and NPR are83.7%,94.8%,93.38%,86.67%,16.27,0.17respectively when using theoptimum cut-off value of serum PCT to diagnose SBP.Prolongedhospitalization days, gastrointestinal tract hemorrhage, serum procalcitoninvalue and neutrophilic granulate percentage increase and abdominaltenderness are risky factors of SBP through the analysis of bi-variableLogistic regression equation.Conclusion: Ascitic fluid culture positive rate is low in SBP patients, andserum procalcitonin acts as a sensitive and specific marker for predictingperitoneal bacteria infection in end-stage liver diseases patients with ascites.Higher serum PCT value could be found in these patients with heavierinfection. By following-up the dynamic changes of serum PCT values, wecould evaluate the effectiveness of anti-bacteria therapies. SBP should bealerted in end-stage liver diseases patients if they have a history ofprolonged hospitalization days, digestive tract hemorrhage, serumprocalcitonin and neutrophilic granulate percentage increase and abdominaltenderness. |
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