Diagnostic Value Of D-dimer For Spontaneous Bacterial Peritonitis

Objective:To explore the clinical value of serum D-dimer assay for diagnosis spontaneous bacterial peritonitis(SBP)in patients with decompensated liver cirrhosis.Providing evidence for early diagnosis of SBP,improving the prognosis and survival rate in SBP patients.Methods:Enrolled the patients with decompensated liver cirrhosis who were admitted to the Third Center Hospital of Tianjin and diagnosed with medium-large amount of ascites by abdominal B-ultrasonography from January 2015 to September2018 as the study objects.The subjects were screened according to the inclusion and exclusion criteria.Clinical data of the enrolled patients were collected and analyzed.Based on the SBP diagnostic criteria proposed by“the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012”,divided enrolled patients into SBP group and non-SBP group.SPSS24.0 software was used for statistical analysis.Results:A total of 265 patients were enrolled and divided into non-SBP group(121cases)and SBP group(144 cases)according to the diagnostic criteria.Child-Pugh grading results of the non-SBP group:7 cases of score A(5.8%),71 cases of score B(58.7%),43 cases of score C(35.5%);Child-Pugh grading results of the SBP group:7cases of score A(4.9%),57 cases of score B(39.6%),and 80 cases of score C(55.6%).White blood cell count,neutrophil percentage,procalcitonin,C-reactive protein level in SBP group were significantly higher than those in non-SBP group(6.52vs.4.69×10~9/L,p=0.003;81.05vs.74.30%,p=0.001;0.66vs.0.30ng/mL,p<0.001;82.15vs.14.05?g/mL,p<0.001),while blood sodium and serum albumin levels were lower than those in the non-SBP group(133.6vs.136.7mmol/L,p<0.001;27.8vs.31.0g/L,p<0.001).The SBP's gram-positive bacteria was 17 cases,gram-negative bacteria was 23 cases.The largest share of gram-negative bacteria was e.coli(10 cases,25%)and klebsiella pneumoniae(9 cases,23%).Binary logistic multi-factors analysis showed Child-Pugh score higher than A,serum creatinine>95?mol/L,prothrombin activity<40%,platelet<100×10~9/L,blood sodium<135mmol/L and albumin/globulin ratio<0.85 were independent risk factors of SBP.Logistics prediction model was logistics(SBP)=16.894+0.802×Child-Pugh C+0.171×Child-Pugh B+0.05×Scr-0.069×PTA-0.07×PLT-0.034×Na~+-1.266×A/G.The area under the ROC curve(95%confidence interval)of the D-dimer diagnosis SBP was 0.858(0.810~0.907).When the cut-off value was 0.725 mg/L,the sensitivity and specificity were 85.3%and 78.4%.The area under the ROC curve(95%confidence interval)of PCT was 0.719(0.675~0.782).When the cut-off value was0.325 ng/mL,the sensitivity and specificity were 75.0%and 61.9%.Conclusion:The proportion of gram-positive bacteria was higher than before,gram-negative bacteria accounted for the main proportion.The mainly pathogenic bacteria were escherichia coli.and klebsiella pneumoniae.Child-Pugh score badder than A,serum creatinine>95?mol/L,prothrombin activity<40%,platelet<100×10~9/L,blood sodium<135mmol/L and albumin/globulin ratio<0.85 are independent risk factors of SBP.When the cut-off value was 0.725 mg/L,the sensitivity and specificity were 85.3%and 78.4%.