الفهرس 
CIRRHOSISOnly 14 pages are availabe for public view
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Abstract
Patients with cirrhosis are usually prone to develop
bacterial infections, primarily spontaneous bacterial
peritonitis (SPB), which is present in 15-25% of patients with
cirrhosis and ascites (Ngamruengphong et al., 2011).
Although, gold standard for diagnosis is based on the
determination of polymorphonuclear (PMN) cells count
equal or greater than 250 cells/mm3 of ascites, with or
without a positive culture (EASL, 2010), in many settings the
results from these gold standard tests are not quickly
available, causing the delay in the diagnosis and early
treatment. For this reason, other methods, more rapid and
widely available have been proposed; such as the use of
reagent strips (Leukocyte esterase dipstick) (Talaat et al.,
2011).
In addition, many patients with SBP may have not
classic symptoms or signs of peritonitis (Nousbaum et al,
2007) nor develop classic manifestations of sepsis. Several
characteristics of the cirrhotic patients may difficult the
diagnosis of the systemic inflammatory response syndrome
(SIRS) and sepsis, for example: Baseline reduced PMN count
due to hypersplenism, baseline elevated heart rate because of
the hyperdynamic circulatory syndrome, baseline
hyperventilation due to hepatic encephalopathy or blunted
elevation of body temperature that is often observed in
cirrhotic patients (Wong et al., 2005).Spontaneous bacterial peritonitis (SPB) is a severe
condition with a high mortality rate if is not diagnosed and
treated promptly and this infection stimulates the immune
system in different forms, such as increase the total
leucocytic count and PMN count in both blood and ascetic
fluid (Yeaman, 2010).
It is possible that the rise in mean platelet volume
(MPV) in bacterial infection is caused by an expanded
creation of bigger and/or more youthful platelets as a
response to the pathogen (Wong, 2013).
An increase in MPV has been observed in chronic
viral hepatitis because of an increase in the entry of newly
produced platelets into circulation, which is larger in volume
than the old platelets (Runyon, 2013).
Other studies of the platelet size in patients with
cirrhosis suggest that the MPV increases in patients with
cirrhosis. These studies also suggest that the MPV increases
more in cirrhotic patients with infections especially SBP and
that it is affected by the severity of the systemic
inflammatory response syndrome (SIRS) associated with
these infections. MPV can be the earliest laboratory tests that
can provide a rapid diagnostic tool for Ascites fluid infection
(AFI) even before performing ascetic fluid sampling and
examination (Gálvez-Martínez et al., 2015).The aim of the resent study is to identify a mean
platelet volume (MPV) cutoff value at which we could be
able to predict the presence of bacterial infection in cirrhotic
patients with ascites.
In our study we found that a statistically significant
increase in MPV levels was observed in cirrhotic patients
with SBP compared to cirrhotic patients without SBP (Pvalue
= 0.001). ROC curve analysis suggested that the
optimum MPV cutoff value for cirrhotic patients with SBP
was 10.25 fL, with a sensitivity and specificity of 85% and
75% respectively (P-value = 0.030).