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Role of serum complement, immunoglobulins, and cell-mediated immune system in the pathogenesis of spontaneous
M Rabinovitz1, J S Gavaler, S Kumar
1University of Pittsburgh, School of Medicine, Pennsylvania 15261.
Abstract:
Spontaneous bacterial peritonitis (SBP) is a common complication of advanced liver disease, which has a reported prevalence of between 4 and 27%. Frequent bacteremias due to inadequate host defense mechanisms, particularly the reticuloendothelial system (RES), with seeding of an ascitic fluid that lacks a normal opsonic activity, is believed to be the principal cause of SBP. Little data exist as to the role of serum levels of complement and immunoglobulins as well as the cell-mediated immune system in the pathogenesis of SBP. The aim of this study was to determine the serum levels of the third and fourth components of complement (C3, C4), total hemolytic complement activity (CH100), and properdin factor B (PFB) and immunoglobulins G, A, and M and various T-cell parameters in individuals admitted to hospital with ascites and advanced liver disease and to determine whether one or more of these factors could be used to predict the development of SBP in patients with advanced liver disease. Fourteen consecutive patients (nine male and five female; age 47.5 +/- 3.1 years, mean +/- SEM) with end-stage liver disease and ascites, who were evaluated for possible liver transplant at the University of Pittsburgh and who developed SBP, comprised the study group. The diagnosis of SBP was determined by positive ascitic fluid culture (three patients) and/or ascitic fluid neutrophil count of greater than 250 cells/mm3 (all patients). The control group consisted of 14 patients, matched for type of liver disease, age, and sex, who did not develop SBP.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Spontaneous bacterial peritonitis (SBP) in advanced liver disease is linked to immune system deficiencies. This study investigated complement, immunoglobulin, and T-cell levels to predict SBP development in patients with ascites.
Area of Science:
- Hepatology and Immunology
- Clinical Microbiology and Infectious Diseases
Background:
- Spontaneous bacterial peritonitis (SBP) is a frequent complication in advanced liver disease, affecting 4-27% of patients.
- Impaired host defense mechanisms, including the reticuloendothelial system (RES) and ascitic fluid opsonic activity, are implicated in SBP pathogenesis.
- Limited data exist on the role of complement, immunoglobulins, and cell-mediated immunity in SBP development.
Purpose of the Study:
- To assess serum levels of complement components (C3, C4), total hemolytic complement activity (CH100), properdin factor B (PFB), and immunoglobulins (G, A, M).
- To evaluate T-cell parameters in patients with ascites and advanced liver disease.
- To determine if these immune factors can predict SBP development in this patient population.
Main Methods:
- Study included 14 patients with end-stage liver disease and ascites who developed SBP.
- Control group comprised 14 matched patients with advanced liver disease and ascites who did not develop SBP.
- SBP diagnosis confirmed by positive ascitic fluid culture and/or neutrophil count > 250 cells/mm3.
Main Results:
- Analysis focused on serum levels of complement (C3, C4, CH100, PFB), immunoglobulins (IgG, IgA, IgM), and T-cell parameters.
- Comparison between SBP and non-SBP groups to identify predictive immune markers.
- Data on specific immune factor levels and their correlation with SBP incidence were collected.
Conclusions:
- Investigated immune system markers in patients with advanced liver disease and ascites.
- Aimed to identify potential predictors for spontaneous bacterial peritonitis (SBP).
- Findings could inform strategies for SBP prevention and management in high-risk patients.