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Ascitic calprotectin and lactoferrin for detection of spontaneous bacterial peritonitis: a systematic review and
Kishan P Patel1, Parker M Korbitz2, John P Gallagher1
1Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Background:
Spontaneous bacterial peritonitis (SBP) is a common bacterial infection in cirrhotic patients associated with a high mortality rate. Prompt diagnosis and early antibiotic administration are crucial in minimizing adverse outcomes. Although detection of ≥250 polymorphonuclear leukocytes (PMN) in ascitic fluid is the current gold standard to diagnose SBP, consideration for rapid detection with biomarkers is warranted.
Methods:
A literature search for studies evaluating ascitic calprotectin and lactoferrin for detection of SBP was performed using PubMed, Embase, Scopus, Google Scholar, Cochrane library, and Clinical Trial Registries. Summary sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the summary receiver operating curve (AUC) were calculated.
Results:
In total, 12 and 13 studies evaluated ascitic calprotectin and lactoferrin, respectively, for detection of SBP. Summary sensitivity, specificity, and LDOR for calprotectin were 0.942 (95% CI, 0.916, 0.967), 0.860 (95% CI, 0.799, 0.935), and 4.250 (95% CI, 3.504, 4.990), respectively. AUC for calprotectin was 0.91. Summary sensitivity, specificity, and LDOR for lactoferrin were 0.954 (95% CI, 0.930, 0.979), 0.890 (95% CI, 0.836, 0.945), and 4.630 (95% CI, 3.800, 5.452), respectively. AUC for lactoferrin was 0.958.
Conclusions:
The overall performance of ascitic calprotectin and lactoferrin was substantial, potentially serving as a screening tool or an alternative to manual cell count. However, a variety of manufacturers, cut-off values, and significant heterogeneity between studies should be noted. Point-of-care testing for calprotectin and lactoferrin may resolve disadvantages associated with the current methods. Future studies on this topic are, therefore, needed.
Insights
Ascitic fluid calprotectin and lactoferrin show high accuracy for diagnosing spontaneous bacterial peritonitis (SBP). These biomarkers may offer a rapid alternative to traditional polymorphonuclear leukocyte counts in cirrhotic patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening infection in patients with cirrhosis.
- Early diagnosis and treatment of SBP are critical for improving patient outcomes.
- Current diagnostic standards for SBP rely on ascitic fluid polymorphonuclear leukocyte (PMN) counts, which can be time-consuming.
Purpose of the Study:
- To evaluate the diagnostic performance of ascitic fluid calprotectin and lactoferrin as biomarkers for SBP.
- To compare the efficacy of these biomarkers against the established diagnostic criteria for SBP.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, Embase, Scopus, etc.) for relevant studies.
- Meta-analysis techniques were employed to calculate summary sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the receiver operating curve (AUC).
Main Results:
- Calprotectin demonstrated a summary sensitivity of 0.942 and specificity of 0.860 (AUC=0.91).
- Lactoferrin exhibited a summary sensitivity of 0.954 and specificity of 0.890 (AUC=0.958).
- Both biomarkers showed substantial diagnostic performance for SBP detection.
Conclusions:
- Ascitic calprotectin and lactoferrin show significant potential as rapid diagnostic tools or screening methods for SBP.
- These biomarkers could serve as alternatives to manual cell counts, potentially improving diagnostic turnaround times.
- Further research is needed to address heterogeneity and explore point-of-care applications for these biomarkers.
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