The Value Of Early Diagnosis Of Serum PCT And WBC/PLT Ratio In Spontaneous Bacterial Peritonitis Complicated By Liver Cirrhosis

AIMS:Liver cirrhosis with spontaneous bacterial peritonitis(SBP)can lead to rapid deterioration,and even lead to liver and kidney failure.It is an important cause of death in patients with end-stage liver disease.However,if detected in time and treated with antibiotics effectively,it can still improve the prognosis of liver cirrhosis [34].SBP is insidious and has various clinical manifestations,so it is difficult to diagnose early.Ascites culture is the gold standard for the diagnosis of SBP,but it often takes 1-3 days and is not suitable for emergency patients.In addition,ascites culture has been negative in about 60% of patients with clinical manifestations suggestive of SBP and increased ascites neutrophil count [20].Recently,the guideline increases procalcitonin(PCT)> 0.5ng/ml as one of the diagnostic criteria for cirrhosis complicated with SBP.This study further explored the relationship between peripheral blood PCT level and WBC/PLT ratio with SBP so as to obtain the early diagnosis of SBP indications.METHOD:A retrospective analysis was used to select 486 patients who were admitted to the Department of Gastroenterology at China-Japan Union Hospital between January 2014 and January 2018 and identified clinically as liver cirrhosis with ascites.Among them,335 were male and 151 were female.This represents 69% and 31% of the total.They were divided into two groups: SBP group and control group.There was no statistical difference in gender and age between the two groups.103 patients with SBP were recruited as SBP group and 383 patients with simple liver cirrhosis were control group.Collect the two times of peripheral blood procalcitonin(PCT),white blood cell(WBC),and platelet(PLT)values at the time of admission and 12 hours after admission in the above patients for antibiotics,and calculate the WBC/PLT ratio.Comparing the SBP group's PCT levels and WBC/PLT ratios with the non-SBP group and the control group.SPSS 22.0 statistical software was used to statistical analysis,and measured data were expressed as mean�standard deviation(x�s).Comparisons between groups were analyzed by analysis of variance and Z test(or rank sum test),and chi-square test was used to compare rates.The diagnostic thresholds of PCT and WBC/PLT were determined based on the receiver operating characteristic curve.RESULT:Merger in 486 patients with cirrhosis combined with ascites.Etiology of hepatitis B,hepatitis C,alcoholic hepatitis and others respectively accounted for 57.2%,18.8%,15.6%,and 8.4% of the total.The Child-Pugh scores and number of complications of the SBP group has significant differences compared with the control group(P >0.05),56.3% of SBP patients had 2 or more kinds of complications,electrolyte disorder,upper gastrointestinal bleeding and hepatic encephalopathy accounted for 44.1%,23.5%,and 14.7% of all complications,respectively.But Hg,Tbil,ALT,AST,LDH,ALB and SCR have no sense between the two groups(P<0.05).The consequence of PCT level in the SBP group(1.76�0.83 ng/mL)was significantly higher than the control group's(0.25�0.16 ng/mL)according to the Z-test(P<0.05),which is similar to the consequence of WBC and WBC/PLT between the two groups.The PCT cut-off value of peripheral blood for diagnosis of SBP was 0.5 ng/mL with a sensitivity of 83.5% and a specificity of 87.7% from the accuracy test.Area under the curve(AUC)was 0.85(95% CI: 0.81 to 0.90);the WBC/PLT ratio threshold was 0.1,the sensitivity was 70.9%,the specificity was 60.1%,and the AUC was 0.72(95%CI: 0.66 to 0.78).PCT combined with WBC/PLT ratio can improve the early diagnosis of SBP.CONCLUSION:1.The incidence of complications of cirrhosis in SBP group was the highest,56.3% of SBP patients had 2 or more kinds of complications,electrolyte disorder,upper gastrointestinal bleeding and hepatic encephalopathy accounted for 44.1%,23.5%,and 14.7% of all complications,respectively.2.PCT and WBC/PLT ratio in SBP group were significantly higher than that in control group(P<0.05).PCT combined with WBC/PLT ratio could be helpful for the early diagnosis of SBP.