Diagnostic Value Of Ascitic Endocan Level For Spontaneous Bacterial Peritonitis In Patients With Decompensated Cirrhosis

BackgroundSpontaneous bacterial peritonitis(SBP)is the most common infection in patients with decompensated cirrhosis and ascites,and it is a common cause of death.Early use of antibiotics can greatly improve prognosis.However,the widespread use of antibiotics increases the bacterial resistance in cirrhotic patients to common antibiotics,which will further increase the mortality of SBP.Most patients with SBP did not show typical clinical manifestations,and only a small proportion of them had a positive ascites culture.Therefore,efforts should be made to find reliable biomarkers for early identification of SBP in order to provide targeted antibiotic treatment to improve prognosis and facilitate the judicious use of antibiotics.ObjectiveTo explore the diagnostic value of ascitic endocan level for spontaneous bacterial peritonitis(SBP)in patients with decompensated cirrhosis.MethodsAscites samples were obtained from patients with decompensated cirrhosis,who were just admitted to our hospital from January 2018 to June2019.One hundred sixty one patients were enrolled,35 of whom were diagnosed as SBP.Demographic and laboratory parameters were collected.The levels of ascitic endocan,TNF-? and IL-6 were measured by ELISA assay.Logistic regression method was used to decide the independent influencing factors for SBP.The correlation between inflammatory markers was analyzed by spearman correlation test.Receiver operating characteristic(ROC)curve were used to analyze the diagnostic value of ascitic endocan level for SBP.ResultsThe levels of ascitic endocan,TNF-? and IL-6 in the SBP group was significantly higher than those in the group without SBP [ 398.451(318.762~460.673)pg/ml vs 199.838(133.366-303.226)pg/ml P<0.001;42.013(10.705~58.128)pg/ml vs 7.838(2.633~12.487)pg/ml P <0.001;1517.31(872.643~2220.45)pg/ml vs 205.239(69.778~283.516)pg/ml P <0.001,respectively ].Correlation analysis showed that ascitic endocan was significantly positively correlated with ascitic PMN(P<0.001,r=0.448),TNF-?(P<0.001,r= 0.292),IL-6(P=0.006,r= 0.216),serum PCT(P<0.001,r=0.318)and CRP(P=0.001,r=0.202).Logistic regression analysis showed that the ascitic endocan level was an independent riskfactor for SBP(OR=1.008,95%CI=1.004 ~ 1.012,P<0.001).The ROC analysis illustrated that the area under the curve(AUC)of ascitic endocan was 0.822(P<0.001),the sensitivity was 88.57% and the specificity was70.63% when the cut-off value was 280.983pg/ml.in patients aged more than or equal to 60 and less than 60,the AUCs of ascitic endocan for the diagnosis of SBP were 0.852 and 0.789 respectively.The AUCs of ascites endocan combined with serum procalcitonin(PCT),serum C-reactive protein(CRP),and percentage of neutrophils(N%),respectively,were0.847,0.854,and 0.845,respectively,which were significantly higher than those of blood PCT,CRP,and N% alone(P = 0.0472,0.0021,0.0033,respectively),but not significantly different from that of ascites endocan alone(P = 0.1243,0.1627,0.3168,respectively).ConclusionThe ascitic endocan level is an independent risk factor for SBP in patients with decompensated cirrhosis,and may serve as a valuable biomarker for diagnosis of SBP.The diagnostic value was greater in patients aged 60 or older.