Mean platelet volume indicator for systemic inflammation in cirrhotic patients with spontaneous bacterial peritonitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Khaled Mohamed Abd El-Wahab ◽  
Moataz Mohamed Sayed ◽  
Mohamed Osama Ali ◽  
Abd El-Azem Mostafa Abd El-Azem
Keyword(s):  
Mean Platelet Volume ◽  
Spontaneous Bacterial Peritonitis ◽  
Platelet Volume ◽  
Bacterial Peritonitis ◽  
Function Test ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B ◽  
Ascetic Fluid

Abstract Introduction spontaneous bacterial peritonitis (SBP) is the most common infection in patients with cirrhosis [1] .Spontaneous bacterial peritonitis is found in patients where besides the increase of polymorphonuclear counting, they present a positive result of culture [2] . The BMN count as not always quickly available in clinical practice and the culture result usually takes 72 hours or more [3] .The use of additional markers that are rapidly and easily applicable, may add significant benefit for predicting the development of spontaneous bacterial peritonitis and achieving diagnostic accuracy [4] .Platelet size is a determinant factor of platelet proinflammatory functions. Several studies have found relationship between the mean platelet volume (MPV) and pro-inflammatory conditions, particularly acute infections [5] . Aim to identify a mean platelet volume (MPV) cutoff value which should be able to predict the presence of sponataneous bacterial peritonitis. Settings and designs a cross sectional observational study, carried out on 40 patients with AFI and 40 patients without AFI. Methods Patients were classified into two groups, group A (SBP) which included 40 patients with ascetic fluid PMN count ≤ 250 cells/mm3 and group B (non/SBP) which included another 40 patients with ascetic fluid PMN count < 250 cells/mm3. All studied patients were subjected to history taking, Clinical examination and routine laboratory investigations including: CBC including platelet number and MPV, liver function test including (ALT, AST, albumin, and direct & total bilirubin), kidney function test including (BUN &creatinine), PT, PTT, INR, ESR and CRP .Abdominal-pelvic ultrasonography was done for all patients. Aspirated ascetic fluid samples were immediately examined for bacteriological cultures. Statistical analysis used Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, independent samples t-test, Chi-square, Mann-Whitney U test and Analysis of variance [ANOVA] tests by SPSS version 22 software .Tukey test was used .Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of MPV and with maximum sensitivity and specificity for differentiation of cirrhotic patients with SBP from those without SBP. Spearman’s correlation analysis was done. Results MPV was significantly higher in SBP-patients (Group A) than that of non-SBP patients (Group B) (11.6820±1.19303 fL versus 9.0325±1.12441 fL) (P-value = 0.001) .MPV has positive correlation with Ascitic sample TLC and Ascitic sample PMNC in Group A. ROC curve shows that MPV cut off value is10.25with 85% sensitivity and 75% specificity . Conclusion MPV may serve as a non-invasive, cheap and rapid test for detection and diagnosis of spontaneous bacterial peritonitis (SBP) with a sensitivity and specificity of 85% and 75% respectively.

scholarly journals EFFICACY OF CIPROFLOXACIN AND CEFOTAXIME IN PATIENTS WITH CIRRHOSIS LIVER PRESENTING WITH SPONTANEOUS BACTERIAL PERITONITIS TO A TERTIARY CARE HOSPITAL

2021 ◽  
Vol 29 (02) ◽  
Author(s):  
Zahidullah Khan ◽  
Ahmar Rashid ◽  
Iqbal Haider ◽  
Shams Suleman ◽  
Aliena Badshah ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Bacterial Peritonitis ◽  
Source Of Infection ◽  
Key Words Ciprofloxacin ◽  
Single Center Study ◽  
Group A ◽  
The Mean ◽  
Group B

Spontaneous Bacterial Peritonitis (SBP), a known complication of cirrhosis Liver is an acute bacterial infection of the peritoneum. Usually no source of infection is easily identifiable. Objective: To compare the efficacy of Ciprofloxacin and Cefotaxime in Cirrhosis Liver patients with SBP. Material and Methods: This prospective, comparative, single center study was conducted in the Department of Medicine, Khyber Teaching Hospital Peshawar from 1st October 2017 to 31st December 2018. A total of 300 admitted patients having Cirrhosis Liver with SBP were included in this study. The patients were randomized into Group A and Group B. Group A was treated with Intravenous Ciprofloxacin and Group B was treated with Intravenous Cefotaxime given twice daily for a period of 5 days. Diagnostic peritoneal paracentesis was done before the start of the treatment and repeated after 5 days therapy. Patients who were either non cirrhotic or had secondary bacterial peritonitis were excluded from the study. Results: A total of 300 Cirrhosis Liver patients with SBP were studied in two equal randomized groups. Out of these 168 were male and 132 were female. The mean age of patients in study was 51.14±11.9 years. The age ranged between 15-75 years. In Group A, 82 percent responded to ciprofloxacin and in group B, 86 percent responded to cefotaxime. Conclusion: Both intravenous ciprofloxacin and cefotaxime are effective in treating spontaneous bacterial peritonitis in patients with Cirrhosis Liver. Key Words: Ciprofloxacin, Cefotaxime, Spontaneous bacterial peritonitis, Efficacy.

scholarly journals Characteristics of ascitic fluid from patients with suspected spontaneous bacterial peritonitis in emergency units at a tertiary hospital

2011 ◽  
Vol 129 (5) ◽  
pp. 315-319 ◽  
Author(s):  
Thiago José Buer Reginato ◽  
Marcelo José Andrade Oliveira ◽  
Luiz César Moreira ◽  
Antonieta Lamanna ◽  
Milena Marques Pagliarelli Acencio ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Hospital ◽  
Emergency Rooms ◽  
Bacterial Peritonitis ◽  
Emergency Room Patients ◽  
Emergency Units ◽  
Group A ◽  
Group B

CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a complication of ascites, especially in cirrhosis. Ascitic fluid with 250 or more neutrophils/mm³ is an acceptable criterion for diagnosis, even when bacterial fluid cultures are negative. The aims here were to estimate SBP frequency among emergency room patients based on cellular criteria and evaluate the biochemical profile of these fluids. DESIGN AND SETTING: Retrospective study at a public tertiary hospital. METHODS: Laboratory records of patients with ascites attended in emergency rooms between November 2001 and November 2006, from whom ascitic fluid samples were sent to the laboratory due to suspected SBP, were evaluated. The 691 samples included were divided into group A (presumed SBP: > 250 neutrophils/mm³; n = 219; 31.7%) and group B (no presumed SBP: < 250 neutrophils/mm3; n = 472; 68.3%). Patients' sex and age; ascitic fluid characteristics (numbers of neutrophils, leukocytes and nucleated cells); bacteriological characteristics; and protein, lactate dehydrogenase, adenosine deaminase and glucose concentrations were evaluated. RESULTS: Among group A cultured samples, 63 (33.8%) had positive bacterial cultures with growth of pathogens commonly associated with SBP. In total, the group A samples showed higher lactate dehydrogenase levels than seen in the group B samples. The latter presented predominance of lymphocytes and macrophages. CONCLUSION: Among the ascitic fluid samples with clinically suspected SBP, 31.7% fulfilled the cellular diagnostic criteria. Positive bacterial isolation was found in 33.8% of the cultured samples from the presumed SBP group

scholarly journals To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

2017 ◽  
Vol 5 (8) ◽  
pp. 3654
Author(s):  
Rajendra Kumar Verma ◽  
Richa Giri ◽  
Mayuri Agarwal ◽  
Vaibhav Srivastava
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Spontaneous Bacterial Peritonitis ◽  
Tertiary Hospital ◽  
Chronic Liver ◽  
Albumin Concentration ◽  
Bacterial Peritonitis ◽  
Presenting Symptoms ◽  
Group A ◽  
Group B

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl. 

scholarly journals Prevalence of impaired renal function in patients of liver cirrhosis with or without spontaneous bacterial peritonitis

2019 ◽  
Vol 9 (1-s) ◽  
pp. 286-289
Author(s):  
Siddhartha Dutta ◽  
Shalini Chawla ◽  
Siddharth Srivastava ◽  
Poonam Loomba ◽  
Vandana Roy
Keyword(s):  
Liver Cirrhosis ◽  
Renal Impairment ◽  
Ascitic Fluid ◽  
Blood Urea Nitrogen ◽  
Spontaneous Bacterial Peritonitis ◽  
Creatinine Ratio ◽  
Bacterial Peritonitis ◽  
Group A ◽  
The Common ◽  
Group B

Background: Renal Impairment (RI) is a common complication in patients with liver cirrhosis and ascites. Spontaneous Bacterial Peritonitis (SBP) a complication in cirrhosis further aggravates and worsens the scenario. Blood urea nitrogen (BUN)/creatinine ratio (BCR) is one of the common laboratory tests used to distinguish prerenal azotemia (PR) from acute tubular necrosis and proves to be handy in absence of other tests. Objective: To find the prevalence of renal impairment in the patients of liver cirrhosis with or without SBP. Design and Setting: Observational, prospective, single centre study. Methods: Cirrhotic patients with SBP or low Ascitic fluid protein were enrolled. RI was considered if the serum creatinine or urea or both were above the reference range. BCR was obtained for each patient and divided based on BCR <20 and BCR>20. Assessment of variability of BCR values was done by further dividing them into eight subgroups (<10, 10–15, 16–20, 21–25, 26–30, 31–35, 36-40 and >40). Results: 34 patients were enrolled and divided into two groups. Group A with 22 patients with SBP and group B with 12 patients with low ascitic fluid protein. Group A had 77.27% patients with RI and group B had 58.33%. Majority of the patients had BCR>20 group denoting a RI of PR type. Three patients had BCR>40 indicating towards a probable gastrointestinal haemorrhage. Conclusion: This study gives an idea about the common occurrence of renal impairment in the patients of liver cirrhosis and ascites which needs early intervention to improve the prognosis.   Keywords: Renal Impairment; Renal failure; Blood urea nitrogen creatinine ratio; BCR Spontaneous Bacterial Peritonitis; Liver cirrhosis

scholarly journals Protective Effects Of Tecomella Undulata Stem Bark Extract On Isoniazid Induced Hepatotoxicity: Based On Liver Enzymes And Histopathology In Rat Model

2019 ◽  
Vol 10 (1) ◽  
pp. 49-52
Author(s):  
Zubaida Umar Zehri ◽  
Shabih Zehra ◽  
Abdul Lateef Mahesar ◽  
M. Anwar ◽  
Syed Ijaz Hussain Zaidi ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Stem Bark ◽  
Bark Extract ◽  
Significant Difference ◽  
Function Test ◽  
Group A ◽  
Stem Bark Extract ◽  
The Mean ◽  
Group B ◽  
Group D

Objective: To evaluate the hepatoprotective effects of Tecomellaundulata stem bark extract on isoniazid induced hepatic damage based on liver enzymes and Liver function test in rat models. Study design and Setting: An experimental study conducted at Department of Pharmacology at Al-Tibri Medical College and Hospital, Isra University Karachi Campus and Dow University of Health Sciences, Karachi. Methodology: Total twenty-four rats were studied. The albino rats that were male, healthy, and weighing 200-250grams were included in this study. Rats were divided into four groups, each group having six rats and treated once daily orally for 30 days. Group A was control group and treated with normal animal diet and water; Group B was Isoniazid treated group and induced by oral administration of Isoniazid (INH) 50mg/kg. Group C was treated with Isoniazid 50mg/kg and Tecomellaundulata bark extract with low dose of 200mg/kg . Group D was treated with Isoniazid 50mg/kg and Tecomellaundulata bark extract with high dose of 400mg/kg . All the animals were weighed before commencement of the study. Liver enzymes were noted after the end of experiment. P value of <0.05 was taken as significant. Results: While comparing the mean values of AST,ALT, ALP and GGT in all four groups group; the statistical significant difference (p<0.001) was found. The mean levels in of total Bilirubin in group A was 0.69 ±0.01, group B 1.04 ±0.04, in group C was 1.15 ±0.39, and in group D was 1.04 ±0.44 with the significant difference (p=0.004). Conclusion: Tecomellaundulata has a protective effect on isoniazid induced toxicity on liver as evidenced by liver function test on rat models.

The Meaning of Serum CRP, ESR, Platelet Count and Mean Platelet Volume ratio(PC/MPV) and plasma Fibrinogen in the Diagnosis of Periprosthetic Joint Infection

2021 ◽  
Author(s):  
Jincheng Huang ◽  
Jingyi Zhang ◽  
Zongyan Gao ◽  
Xiao Chen ◽  
Zhipeng Dai ◽  
...  
Keyword(s):  
Platelet Count ◽  
Mean Platelet Volume ◽  
Joint Infection ◽  
Volume Ratio ◽  
Threshold Value ◽  
Plasma Fibrinogen ◽  
Platelet Volume ◽  
Group A ◽  
Group B ◽  
Serum Crp

Abstract BackgroundThe purpose of this study was to test the meaning of serum CRP, ESR, Platelet Count and Mean Platelet Volume ratio (PC/MPV) and plasma Fibrinogen in periprosthetic joint infection diagnosis. MethodsClinical data of 160 patients diagnosed with osteoarthritis (Group A), PJI (Group B) and aseptic loosening after joint arthroplasy (Group C) were retrospective studied. General data and preoperative serum CRP, ESR, Platelet count to Mean Platelet Volume ratio and plasma Fibrinogen level were recorded and compared.ResultsSerum CRP, ESR, PC/MPV and plasma Fibrinogen expression level in Group B are much higher than Group A and C. When PC/MPV>31.70 was set as the optimum threshold value for the diagnosis of PJI, the specificity of PC/MPV in PJI diagnosis was lower than CRP and ESR, whereas, the sensitivity of PC/MPV in PJI diagnosis was similar with CRP and ESR. When plasma Fibrinogen > 4.01 μg/mL was set as the optimum threshold value for the diagnosis of PJI, the specificity and sensitivity of plasma Fibrinogen in diagnosis of PJI was similar with CRP and ESR. ConclusionPC/MPV should not be used as the first screen marker for PJI diagnosis, whereas, the plasma Fibrinogen can be used as a new marker for PJI diagnosis.

scholarly journals The validity of Triggering Receptor Expressed on Myeloid Cells (TREM-1) in diagnosis of Spontaneous Bacterial Peritonitis in cirrhotic patients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W Abdelmonsef ◽  
N A Abdelkader ◽  
G A Ismail ◽  
M M Elgaafary ◽  
Y A Abdelrazek
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Ascitic Fluid ◽  
Spontaneous Bacterial Peritonitis ◽  
Chronic Liver ◽  
Statistical Significant Difference ◽  
Bacterial Peritonitis ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Mean

Abstract Background Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients with ascites. Without early antibiotic treatment, this complication is associated with a 30-50% mortality rate. Recently we have evaluated the validity and utility of ascitic fluid triggering receptors expressed on myeloid cells-1 (TREM-1) levels for the diagnosis of SBP. Patients and Methods This was a Prospective case control study conducted on 60 patients with chronic liver disease and ascites divided into two group, group 1 (control) 30 patients without SBP and group 2 (SBP) 30 patients, admitted to the Tropical Medicine Department with ascites due to chronic liver disease. All patients were subjected to full history taking and clinical examination full laboratory investigations including complete blood picture liver and renal profiles, C reactive protein, viral markers, abdominal ultrasound, UGI endoscopy and ascitic fluid sampling for biochemical testing, total and differential cell count, microbiological culture and TREM-1 level. Results There was high statistical significant difference between the two groups in the base level of TREM-1 in which the mean was 1280 pg/ml (1136.9) with level range between (580---4500pg/ml) in SBP versus mean 129.9 pg/ml (51.9) with level range between (60-250pg/ml) in the control group. Also there was a statistical significant difference in the level of TREM-1 before and after treatment in the SBP patients in which the mean of TREM-1 before treatment was 1280.6 pg/ml (1136.9) with level range between (580-4500pg/ml) versus mean 376.2 pg/ml (78.4) and level range between (260-560 pg/ml) after the treatment. Conclusion our data indicate that the measurement of ascitic fluid TREM-1 is rapid, easy and valid test in the diagnosis and follow up of chronic liver disease patients with SBP.

POSSIBLE ROLE OF HYPERAMMONAEMIA AND/OR OF PORTOSYSTEMIC SHUNTS ON THE VARIABILITY OF THE TSH RESPONSE TO TRH IN CIRRHOTIC PATIENTS

1978 ◽  
Vol 89 (2) ◽  
pp. 284-295 ◽  
Author(s):  
J. L. Schlienger ◽  
M. Hasselmann ◽  
M. Imler
Keyword(s):  
Liver Disease ◽  
Disease Group ◽  
Portosystemic Shunts ◽  
Advanced Cirrhosis ◽  
Free Thyroxine Index ◽  
Group A ◽  
Cirrhotic Patients ◽  
The Mean ◽  
Group B

ABSTRACT Serum concentrations of thyroid hormones (T3, T4) and the TSH response to TRH administered iv were measured by radioimmunoassay in 21 patients with advanced cirrhosis and compared to 20 control patients without liver disease (group A). While the mean T4 values (8.6±0.3 μg/100 ml) were similar for the two groups, the mean T3 values were significantly lower in patients with liver disease (123 ± 12 vs. 156 ± 10 ng/100 ml). The mean baseline TSH levels and the magnitude of the peak were normal but very scattered in these patients. The TSH response to TRH appeared independant of nutritional status, T4 and T3, anaemia, hypoalbuminaemia, transaminasaemia and bilirubinaemia. The TSH release after TRH injection seemed however to be markedly elevated in cirrhotic patients with hyperammonaemia. Therefore, patients with liver disease were separated into two groups according to the absence (group B; n = 11) or the presence (group C; n = 10) of hyperammonaemia. Mean T4 values and the free thyroxine index were lower in group C (7.2 ± 0.6 vs. 9 ± 0.6 μg/100 ml and 1.87 ± 0.16 vs. 2.49 ± 0.15) but mean T3 and basal TSH values did not differ in group B and C. The TSH response was slightly dispersed in B and lower than that observed in A or in C (P < 0.01). A hyperresponsiveness in 4 patients and a hyperresponsiveness in 2 other patients was noted in group C without any correlation with the basal TSH value or T3 or T4 Since hyperammonaemia has been considered as a biological parameter of hepatic encephalopathy, it is suggested that the THS release which is neuraminergic controlled may be altered by this situation resulting in a cerebral aminergic mediators depletion.

scholarly journals Plasma Fibrinogen is a good new auxiliary diagnostic marker for periprosthetic joint infection

2020 ◽  
Author(s):  
Jincheng Huang ◽  
Xiao Chen ◽  
Shuo Qiang ◽  
Wendi Zheng ◽  
Jia Zheng ◽  
...  
Keyword(s):  
Platelet Count ◽  
Mean Platelet Volume ◽  
Joint Infection ◽  
Volume Ratio ◽  
Plasma Fibrinogen ◽  
Platelet Volume ◽  
Group A ◽  
Group B ◽  
Serum Crp ◽  
D Dimer

Abstract Background: To test the meaning of serum CRP, ESR, Platelet Count and Mean Platelet Volume ratio (PC/MPV), plasma Fibrinogen and D-Dimer in periprosthetic joint infection diagnosis (PJI). Methods: Clinical data of 149 patients diagnosed with osteoarthritis (Group A), PJI (Group B) and aseptic loosening after joint arthroplasy (Group C) were retrospectively studied. General data and preoperative serum CRP, ESR, Platelet Count and Mean Platelet Volume ratio (PC/MPV), plasma Fibrinogen and D-Dimer levels were analyzed. The sensitivity and specificity of serum CRP, ESR, Platelet Count and Mean Platelet Volume ratio (PC/MPV), plasma Fibrinogen and D-Dimer in PJI diagnosis were compared.Results: Expression level of serum CRP, ESR, PC/MPV and plasma Fibrinogen in Group B are higher than Group A and C. Expression level of plasma D-Dimer in Group B are higher than Group A but similar with Group C. When PC/MPV>31.70, plasma Fibrinogen > 4.01 μg/mL and plasma D-Dimer > 1.17 mg/L were set as the threshold value for the diagnosis of PJI, the sensitivity of PC/MPV in PJI diagnosis is lower than ESR and Plasma Fibrinogen. Whereas, there are no statistically significant differences when compared specificity of serum CRP, ESR, PC/MPV, plasma Fibrinogen and D-Dimer in PJI diagnosis.Conclusion: PC/MPV and plasma D-Dimer should not be used as the first screen markers for PJI diagnosis, whereas, the plasma Fibrinogen can be used as a new auxiliary marker for PJI diagnosis.

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