Study for the Significance of Ascetic Fluid Lactoferrin in Diagnosis of Spontaneous Bacterial Peritonitis in Decompensated Liver Cirrhosis
Authors: Fouad Abdou Amir Raouf , Ahmed Osama Ashraf , Ghit Ramy Samir , Fahmy Mohamed Lotfy 
Published: November 2024

Abstract

Background
Cirrhosis represents the inal common histological pathway for a wide variety of chronic liver diseases. Occurrence of ascites is the most common presentation of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is observed in 15–26% of patients hospitalized with ascites. SBP is deined as the infection of AF in the absence of a contiguous source of infection and/or an intra-abdominal inlammatory focus. An AF-polymorphonuclear (PMN) leukocyte count more than or equal to 250/mm irrespective of the AF culture result is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently, the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner.

Aim of the Work
to use AF lactoferrin for the diagnosis of SBP and to identify a clinically useful marker that can be used for future development of an important clinical, economic, and time saving rapid bedside test for the diagnosis of SBP in cirrhotic ascites.

Patients and Methods
This study was conducted on 60 patients with decompensated chronic liver disease and ascites with and without spontaneous bacterial peritonitis admitted to Gastroenterology and Hepatology department inpatient and outpatient clinics at Ain Shams University Hospitals and labs, from April 2023 to September 2023.

Results
Females were affected more than males by SBP, SBP has higher incidence in elderly compared to control group No significant difference between studied groups regards to risk factors and Child class (p &gt; 0.05). HCV infection was the main etiology of liver cirrhosis in both groups while HBV infection was much less common with no significant difference between studied groups (p &gt; 0.05). Patients in SBP group showed positive reaction to CRP compared to control group with significant difference between them (p &lt; 0.05). No statistical significant differences between studied groups regards to abdominal ultrasonographic indings (p &gt; 0.05). Liver enzymes (ALT and AST) were higher in SBP patients compared to non SBP patients with signiicant difference between them (P &lt; 0.05). SBP patients have higher TLC and lower MCV and platelets count compared to non SBP patients with signiicant difference between them (P &lt; 0.05). No statistical signiicant difference between studied groups regards to INR, Hb and MCH values (p &gt; 0.05).

Conclusion
Outcomes of our study provide evidence of the clinical usefulness of AF lactoferrin levels in patients with cirrhosis to differentiate those with and without SBP. It is important to note that the correlation of lactoferrin levels and inlammatory markers in blood samples and AF could be inluenced by lysis of PMN cells during transport to the laboratory, which could lead to a false negative result. Moreover, manual measurement of the AF and PMN count is operator dependent, which makes quality control difficult. Commercially available kits for the measurement ascetic luid lactoferrin could be used in a future development of qualitative bedside assay.