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High sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites

Kerim Guler1, Sezai Vatansever, Seyit Mehmet Kayacan

  • 1Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University.

Hepato-Gastroenterology
|July 8, 2009
PubMed
Abstract

Insights

Serum high sensitivity C-reactive protein (hsCRP) can help diagnose spontaneous bacterial peritonitis in cirrhotic ascites patients, even with low white blood cell counts. Elevated hsCRP levels also indicate treatment effectiveness.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Clinical Chemistry

Background:

  • Spontaneous bacterial peritonitis (SBP) diagnosis in cirrhotic ascites typically relies on polymorphonuclear leukocyte (PMN) counts ≥250/mm³.
  • A subset of patients with SBP presents with nonneutrocytic ascites (PMN <250/mm³), posing diagnostic challenges.
  • Serum high sensitivity C-reactive protein (hsCRP) is investigated for its diagnostic utility in such cases.

Purpose of the Study:

  • To evaluate the diagnostic value of serum hsCRP in patients with spontaneous bacterial peritonitis and nonneutrocytic ascites.
  • To assess the correlation between hsCRP levels and the presence of SBP.
  • To determine the utility of hsCRP in monitoring treatment response.

Main Methods:

  • Patients with decompensated cirrhosis were categorized into three groups based on clinical signs and ascitic fluid PMN counts.
  • Group 1: Peritonitis signs, PMN ≥250/mm³. Group 2: Peritonitis signs, PMN <250/mm³. Group 3: No peritonitis signs, PMN <250/mm³.
  • Serum hsCRP levels were measured at baseline and after two days of ceftriaxone treatment in Groups 1 and 2.

Main Results:

  • Mean serum hsCRP levels were significantly higher in Groups 1 (68.4 mg/dl) and 2 (68.3 mg/dl) compared to Group 3 (6.5 mg/dl) (p < 0.0001).
  • Following two days of ceftriaxone, hsCRP levels decreased significantly in both Group 1 (9.0 mg/dl) and Group 2 (9.1 mg/dl).
  • These findings suggest hsCRP levels are elevated in SBP, irrespective of PMN count.

Conclusions:

  • Elevated serum hsCRP levels can effectively differentiate patients with spontaneous bacterial peritonitis from those without, even in cases of nonneutrocytic ascites.
  • Serum hsCRP demonstrates potential as a biomarker for assessing treatment response in SBP.
  • This study highlights the role of hsCRP in diagnosing and managing SBP in challenging clinical scenarios.

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