Search In this Thesis
   Search In this Thesis  
العنوان
The role of serum Procalcitonin levels in the prediction and diagnosis of spontaneous bacterial peritonitis in hospitalized patients with liver cirrhosis /
المؤلف
Elbasuony, Reham Mohammed Mohammed.
هيئة الاعداد
باحث / ريهام محمد محمد البسيوني
مناقش / تاري عبد الحميد سلمان
مناقش / أحمد أحمد الشعراوي
مشرف / محمود حلمي علام
الموضوع
Liver - Cirrhosis. Liver Cirrhosi.
تاريخ النشر
2016.
عدد الصفحات
145 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الكبد
تاريخ الإجازة
31/7/2016
مكان الإجازة
جامعة المنوفية - معهد الكبد - طب الكبد
الفهرس
Only 14 pages are availabe for public view

from 145

from 145

Abstract

Ascites is a common complication of cirrhosis. The development of ascites marks the onset of worsened prognosis and increased mortality in patients with cirrhosis. Ascites causes considerable morbidity in the affected individual by producing abdominal distension, respiratory distress, development of hernias especially paraumbilical, worsening of nutritional status, and increased susceptibility to infections (Hou and Sanyal, 2009). Spontaneous bacterial peritonitis (SBP) is a very common bacterial infection in patients with cirrhosis and ascites (Wong et al., 2005).When first described, its mortality exceeded 90% but it has been reduced to approximately 20% with early diagnosis and treatment (Tandon Garcia-Tsao, 2008). The diagnosis of SBP is proved in the presence of an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (i.e., ≥250 cells/ mm3 [0.25 /L]) without an evident intra-abdominal, surgically treatable source of infection (Hoefs et al., 1982) In severe infection, most classical proinflammatory cytokines (e.g. TNF-α, IL-1β or IL-6) are increased only briefly or intermittently, if at all. Despite the use of new treatment modalities (Bernard et al., 2001), mortality in sepsis remains high, often due to delayed diagnosis and treatment. In view of this diagnostic and therapeutic dilemma, an unequivocal test for the differential diagnosis of infection and sepsis would be very useful. In microbial infections and in various forms of severe systemic inflammation, circulating levels of calcitonin precursors (CTpr), including the prohormone procalcitonin (ProCT), increase several folds to several thousand-folds, and this increase often correlates with the severity of the condition and with mortality (Muller et al., 2000). Forty-eight patients attending the ward of Hepatology Department, National Liver Institute, Menoufiya University were recruited in this study. They were decompensated cirrhotic patients with absence of systemic diseases, hepatocellular carcinoma were our conditions to be enlisted in this study. We relied on ascitic fluid sample count of TLC for proper diagnosis of SBP. Patients were classified into two groups. group I “with” SBP and group II “without” SBP. After an informed consent, all patients were subjected to thorough history taking, physical examination, baseline laboratory tests; ”CRP, Procalcitonin test & Ascitic sample tests (TLC, LDH, glucose, total protein &albumin). All patients took 5 days antibiotic then all labs were re-withdrawn. The results of our study showed that:  Twenty four patients with SBP were 17 males (70.8%) and 7 females (29.2%)  Twenty four patients without SBP were 10 males (41.7%) and 14 females (58.3%)  Serum CRP had a sensitivity of 75% and a specificity of 75 % for diagnosis of SBP, with the accuracy of 71.6% & area under curve 0.72 [confidence interval (CI): 0.56-0.88, p <0.01).  Serum Procalcitonin had a sensitivity 100% and a specificity 83.3% for SBP diagnosis, with the accuracy of 99.9% & area under curve 0.997 [confidence interval (CI): 0.987-1.000, p <0.01).  WBCs had sensitivity 75.0% and specificity of 70.9% for SBP diagnosis, with the accuracy of 81.2% & area under curve 0.79 [confidence interval (CI): 0.65-0.92, p <0.01).