Analysis Of The Diagnostic Value Of MPV,NLR And WBC In Cirrhotic Patients With Spontaneous Bacterial Peritonitis

Objectives:Spontaneous bacterial peritonitis(SBP)is the most common infection in patients with decompensated liver cirrhosis,which can easily induce hepatic encephalopathy,hepatorenal syndrome,liver failure,and even multiple organ failure.The prognosis is poor and prone to relapse.Studies have found that early diagnosis of SBP and application of empirical antibiotics are important factors in reducing mortality.The diagnostic criteria based on a positive ascites culture or ascites polymorphonuclear leukocytes(PMN)count?250×10~6/L have certain limitations.Therefore,it is necessary to find new sensitive biomarkers to guide clinical empirical antibacterial treatment,thereby optimizing SBP patient management.The aim of this study is to assess the correlation between inflammation indicators in peripheral blood and the occurrence of SBP,and to explore the diagnostic value of multi-factor joint model based on NLR and MPV for SBP.Research methods:Patients with cirrhosis and ascites admitted to our Hospital from September 2017to October 2019 were selected.Collect patient age,gender,etiology of cirrhosis,complications of cirrhosis,Child-Pugh score,white blood cell count,hemoglobin,neutrophil ratio,lymphocyte count,mean platelet volume,platelet distribution width,serum creatinine,serum bilirubin,Serum albumin,alanine aminoconvertase,aspartate aminoconversion,prothrombin time,international normalized ratio,C-reactive protein(CRP),ascites PMN counts and calculating NLR.Univariate and multivariable binary logistics regression analysis were used to identify the independent risk factors related to the occurrence of SBP,so as to establish the multi-factor joint model based on NLR and MPV.Determine the area under the curve(AUC)of model by drawing the receiver operating characteristic curve(ROC curve),and the cut-off value,sensitivity,specificity,positive predictive value and negative predictive value of the diagnosis of SBP were calculated.P<0.05 was considered statistically significant.Research results:Analysis of basic characteristics of 174 patients with cirrhosis and ascites.Among the etiology of cirrhosis,hepatitis B accounted for 60.3%,and alcoholic hepatitis accounted for 23.0%.Hepatitis C and other causes respectively accounted for(10.9%),(5.7%).The complications in the SBP group were significantly increased,mainly including esophageal varices bleeding,hepatic encephalopathy and hepatorenal syndrome.The levels of PDW,MPV,NLR,WBCand CRP in the SBP group are significantly higher than those in the non-SBP group(P<0.05).The multivariable regression analysis confirmed that MPV,NLR and WBC were independent risk factors of SBP with OR(95%CI)of 1.908(1.353-2.691),1.1169(1.005-1.238)and1.200(1.044-1.379)repectively.The model is established according to multivariable logistics regression analysis.The formula is as follow:-10.353+0.151×NLR+0.651×MPV+0.206×WBC.ROC analysis show that when the cut off value is 0.18,the curve of the model is 0.875,the sensitivity is 76.67%,the specificity is 81.69%.The AUC of NLR,MPV,and WBC are 0.769,0.795 and 0.707,respectively,which are all smaller than the AUC for model diagnosis of SBP.It indicates that the value of the model diagnosis SBP is higher than NLR,MPV,WBC.Research conclusions:1.The levels of NLR,MPV,and PDW in the SBP group are significantly elevated compared to the non-SBP group.NLR and MPV are independent risk factors of SBP.2.The model based on MPV and NLR has better diagnostic value than MPV,NLR and WBC alone diagnosis..