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Elevated C-reactive protein and spontaneous bacterial peritonitis in children with chronic liver disease and ascites

Marcela Preto-Zamperlini1, Sylvia Costa Lima Farhat, Maria Beatriz Moliterno Perondi

  • 1*Department of Pediatric Emergency †Department of Pediatric Hepatology ‡Department of Pediatric Emergency Department, Children's Institute, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Journal of Pediatric Gastroenterology and Nutrition
|September 21, 2013
PubMed

Insights

C-reactive protein (CRP) aids in detecting spontaneous bacterial peritonitis (SBP) in children with liver disease. Elevated CRP levels and lower albumin levels indicate SBP, with Streptococcus pneumoniae being the most common cause.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Infectious Diseases

Background:

  • Chronic liver disease in children often leads to ascites.
  • Ascites can predispose children to spontaneous bacterial peritonitis (SBP).
  • Early and accurate diagnosis of SBP is crucial for effective management.

Purpose of the Study:

  • To compare laboratory markers of SBP versus non-infected ascites in pediatric patients.
  • To identify infectious agents responsible for SBP in this population.
  • To evaluate the diagnostic utility of C-reactive protein (CRP) in SBP.

Main Methods:

  • Retrospective review of medical records for 90 children with chronic liver disease and ascites.
  • Analysis of laboratory data including blood counts, coagulation, liver/renal function, CRP, albumin, and cultures.
  • Examination of ascitic fluid from 152 paracentesis procedures for cytology, Gram stains, neutrophil counts, and cultures.

Main Results:

  • Children with SBP showed significantly lower albumin and higher CRP levels, prothrombin times, INR, and leukocyte counts compared to non-infected ascites.
  • CRP was identified as an independent predictor of SBP.
  • Streptococcus pneumoniae was the most frequent pathogen identified in SBP cases (44%).

Conclusions:

  • C-reactive protein (CRP) shows promise as a valuable biomarker for the early detection and monitoring of SBP in children with liver disease.
  • Laboratory indices like CRP and albumin levels can help differentiate SBP from non-infected ascites.
  • Understanding causative agents like Streptococcus pneumoniae is important for targeted therapy.
Abstract

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