The Study of the Diagnostic Value of Ascetic Fluid C-Reactive Protein, Calprotectin and Calprotectin–Ascetic Albumin Ratio
Authors: Mohammed Khaled Abdelhamed , Talkawy Mohammed Darwish El , Mohammed Manal Sabry , Salama Mohammed Magdy , Fat-Helbary Islam Raafat Elshafei 
Published: August 2023

Abstract

Background
Cirrhosis represents the final common histological pathway for a wide variety of chronic liver diseases. Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodule. Some patients with cirrhosis are completely asymptomatic and have a reasonably normal life expectancy

Aim of the Work
The aim of the study is to evaluate the usefulness of Ascetic Fluid Calprotectin and CRP for the diagnosis of SBP.In addition, we will evaluate Ascetic fluid calprotectin-toalbumin ratio in the diagnosisof SBP. and to identify a clinically useful cut-off level that can be used for future development of an important clinical, and time saving for the diagnosis of SBP

Patients and Methods
This case control study was conducted at Ain Shams University Hospital and Theodorbilharz Reaserch institute to evaluate the usefulness of ascetic fluid calprotectin, CRP and calprotectin-to-albumin ratio for the diagnosis of SBP and to identify a clinically useful cut-off level that could be used for future development of an important clinical and time saving method for diagnosis of SBP. Fifty cirrhotic patients with ascites were divided into two groups; group 1 (non SBP control group) that included 25 patients with cirrhotic ascites without SBP and group 2 (SBP group) that included 25 patients with cirrhotic ascites with SBP.

Results
Regarding demographic data; statistical analysis of current results showed that there was no statistically significant difference between the two groups regarding mean age 60.20±8.86 compared to 63.04±6.86 (p = 0.211) and sex 12 patients (48%) and 13 patients (52%) were female and male, respectively compared to SBP Group were 14 patients (56%) and 11 patients (44%) were female and male respectively with (p = 0.478). Regarding ascetic fluid biochemical; statistical analysis of current results showed that there was a statistically significant difference between two groups according to AF CRP, AF Calprotectin, Calprotectin-Albumin Ratio and AF TLC (p &lt; 0.05). The highest value was found in SBP Group (21.09±15.86), (196.72±135.00), (379.60±354.71) and (756.04±513.50) compared to Non SBP Group (8.73±7.04), (119.30±111.31), (187.83±186.07) and (196.00±105.99) respectively. While, there was no statistically significant difference between two groups according to AF Albumin and Neutrophil%, with p-value (&gt;0.05 NS).

Conclusion
In cirrhotic patient with ascites, AF CRP, AF Calprotectin and Calprotectin –Ascetic Albumin ratio were useful and sensitive diagnostic parameters and seem to provide a satisfactory diagnostic accuracy in diagnosis of spontaneous bacterial peritonitis. The sensitivity and specifity of AF calprotectin is higher than AF CRP and AF calprotectin albumin ratio in diagnosis spontaneous bacterial peritonitis cases. There was significant positive correlation between AF Calprotectin and AF CRP and AF calprotectin albumin ratio among patient with spontaneous bacterial peritonitis. If no contraindications, AF CRP, AF Calprotectin and Calprotectin –Ascetic Albumin ratio measurements could be used for diagnosis of SBP with high diagnostic and accurate value.