Analysis Of The Value Of Ascitic Prostaglandin E2 Level In Diagnosis Of Spontaneous Bacterial Peritonitis And Prediction Of In-hospital Mortality

BackgroundSpontaneous bacterial peritonitis(SBP),the most common infection in patients with decompensated cirrhosis,is a vicious and recurrent infection of ascites and frequently induces liver failure,hepatic encephalopathy,hepatorenal syndrome and coagulopathy.Diagnosis of SBP is based on ascitic fluid polymorphonuclear leukocytes(PMN)count?250/mm~3 or positive culture of ascitic fluid and excluding intra-abdominal infection or surgical history.Since ascitic fluid PMN count is measured manually,which is operator-dependent and making quality control difficult,moreover,the positive rate of ascitic fluid culture is low.Thus,the early diagnosis of SBP remains a problem.However,early antibiotic treatment is particularly important for successful treatment of SBP and reduction of mortality.Therefore,the development of new biomarkers to diagnose SBP or predict the mortality is significant for improving the prognosis of patients with decompensated cirrhosis.ObjectiveTo explore the value of ascitic prostaglandin E2(PGE2)level in diagnosis of SBP and prediction of in-hospital mortality in patients with decompensated cirrhosis and compare ascitic PGE2 with other inflammatory index.MethodsPatients with decompensated cirrhosis and ascites admitted to the First Affiliated Hospital of Chongqing Medical University from June 2017 to August 2018 were enrolled.Demographic and laboratory parameters,such as age,sex,temperature,cause of cirrhosis,comorbidities,white blood cell,neutrophils cells,serum creatinine,serum bilirubin,serum albumin,prothrombin time,international normalized ratio,procalcitonin(PCT),C-reactive protein(CRP),MELD score and Child-Pugh score,were recorded at the time of paracentesis and ascitic PGE2 levels were detected by ELISA.The sensitivity and specificity of ascitic PGE2 and area under the curve(AUC)in diagnosis of SBP were analyzed by receiver operating characteristic(ROC)curve.Univariate and multivariate logistic regression analysis were used to analyze the predictors of in-hospital mortality.ResultsOne hundred and ninety three patients were enrolled,30(15.5%)patients were diagnosed as SBP.The level of ascitic PGE2 in the SBP group was 32.77(26.05-39.68)pg/ml,which was significantly lower than that in the group without SBP[49.72(37.35-55.14)pg/ml,P=0.000].In ROC analysis,the AUC of ascitic PGE2 was 0.80,the cut-off value was40.30 pg/ml,the sensitivity was 93.3%,and the specificity was 58.3%.The AUC of white blood cells,neutrophils,PCT,and CRP were 0.75,0.76,0.67,and 0.57,respectively.A total of 13(6.7%)of the 193 patients died during hospitalization.The level of ascitic PGE2 of patients in the death group[32.77(24.05-47.50)pg/ml]was significantly lower than that in the non-dead group[44.22(34.29-54.72)pg/ml,P=0.005].In univariate analysis of predictors for in-hospital mortality,the OR value of ascites PGE2?32.88 pg/ml was 7.690(95%CI 2.357-25.088,P=0.001).In the multivariate model analysis,the OR value of ascites PGE2?32.88 pg/ml was 11.431(95%CI 1.376-94.929,P=0.024).ConclusionAscitic PGE2 level may be a valuable biomarker for the diagnosis of SBP and prediction of in-hospital mortality in patients with decompensated cirrhosis.