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Granulocyte elastase in cirrhotic patients with spontaneous bacterial peritonitis
F Casafont1, M Rivero, M D Fernandez
1Department of Hepatogastroenterology, University Hospital Marqués de Valdecilla, Santander, Spain.
Abstract:
Granulocyte elastase (GE) is a powerful proteolytic enzyme that is released by PMNs when degranulated in infectious processes. The aim of this study was to measure GE in ascites and plasma of cirrhotic patients with spontaneous bacterial peritonitis (SBP). We studied 29 cirrhotic patients, 17 of them having SBP (group A). Twelve patients with noninfected ascites formed the control group (group B). At the time of diagnosis of SBP, GE levels in ascites (183.17 +/- 86.11 microg/liter) and plasma (114.6 +/- 35.99 microg/liter) were higher in group A than in group B (27.41 +/- 11.54 microg/liter, P < 0.00001 and 82.54 +/- 20.52 microg/liter, P = 0.01, respectively). Levels of GE in ascites had a high value for discriminating between patients with and without SBP. In the patients who responded to the initial antibiotic treatment, these values significantly decreased in ascites (67.69 +/- 54.22 microg/liter, P = 0.003) and plasma (67 +/- 22.39 microg/liter, P = 0.01) 48 hr after therapy was started, in parallel with the decrease of PMN in ascites. In patients who did not respond, the production of GE remained elevated. Patients who developed renal insufficiency following SBP had more marked elevation of GE in plasma (144.8 +/- 33.43 microg/liter) than those with normal renal function (99.5 +/- 27.53 microg/liter, P = 0.02). These results suggest that the measurement of GE may be helpful for the diagnosis of SBP in patients with cirrhosis and for assessing the efficacy of therapy. In addition, the release of GE into plasma may contribute to the impairment of renal function that follows SBP in some patients.
Insights
Granulocyte elastase (GE) levels in ascites and plasma are significantly higher in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Measuring GE aids in diagnosing SBP and monitoring treatment effectiveness.
Area of Science:
- Hepatology
- Infectious Diseases
- Biochemistry
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients.
- Polymorphonuclear neutrophils (PMNs) release granulocyte elastase (GE) during infection.
- Diagnostic markers for SBP are crucial for timely intervention.
Purpose of the Study:
- To quantify granulocyte elastase (GE) levels in ascites and plasma of cirrhotic patients.
- To evaluate GE as a diagnostic marker for spontaneous bacterial peritonitis (SBP).
- To assess the correlation between GE levels and SBP treatment response and renal function.
Main Methods:
- Measurement of GE concentrations in ascites and plasma samples.
- Comparison of GE levels between cirrhotic patients with SBP and a control group.
- Monitoring GE levels before, during, and after antibiotic therapy for SBP.
Main Results:
- Significantly elevated GE levels in ascites and plasma of SBP patients compared to controls.
- GE levels decreased significantly post-antibiotic treatment, correlating with reduced PMNs.
- Higher plasma GE levels were observed in SBP patients who developed renal insufficiency.
Conclusions:
- Granulocyte elastase (GE) measurement is a valuable tool for diagnosing SBP in cirrhotic patients.
- GE levels can help assess the efficacy of antibiotic therapy for SBP.
- Elevated plasma GE may indicate an increased risk of renal impairment following SBP.