Ascitic procalcitonin as a diagnostic and prognostic marker of spontaneous bacterial peritonitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amira Ahmed Salem ◽  
Sarah Abd ElKader ElNakeep ◽  
Ahmed Mohamed ElGhandourl ◽  
Mohamed Ahmed Ahmed Mohamed
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Prognostic Marker ◽  
Ascitic Fluid ◽  
Neutrophil Count ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Group A ◽  
Group B

Abstract Background SBP is a condition that requires a high index of suspicion, rapid and accurate diagnosis in addition to prompt and effective therapy. It is also characterized by a high recurrence rate within one year of the 1st episode. Objective Evaluation of ascitic fluid procalcitonin as a possible diagnostic and prognostic marker for spontaneous bacterial peritonitis and to study its role in diagnosis of SBP with no increase in the neutrophil count (where neutrophils in the ascitic fluid are less than 250 per ccm while the culture is positive). Patients and Methods Study was conducted at Hepatology and Gastroenterology Department in Ahmed Maher Teaching Hospital and Internal Medicine Department in Ain Shams University from January 2019 till July 2019. Total number of 50 patients with cirrhotic ascites entered this study were divided into three groups: Group A (patient group): 20 patients with SBP as diagnosed by 250 neutrophils or greater per cmm of the ascitic fluid as present in the guidelines. Group B (patient group): 20 patients with criteria suggestive of SBP (abdominal pain, fever, liver function deterioration, leukocytosis in the CBC with no other localization for the infection), but shows neutrophil count in the ascitic fluid less than 250 i.e not diagnostic by itself. Only Patients with positive culture will be included in this group. Group C (control group): 10 patients with ascites,but no evidence of SBP (symptomatic or laboratory) as the control. Results Ascitic fluid procalcitonin level was statistically significant higher in both groups A&B (SBP group) than group C (non-SBP group). As regards Group A VS Group B+ Group C: The cutoff point is 520 (pg). Its sensitivity is 95%. Its specificity is 53.3%. The AUC is 0.633. The positive predictive value is 57.6%. The negative predictive value is 94.1%. Regarding Group B VS Group C: The cut-off point is 300 (pg). Its sensitivity is 85%. Its specificity is 70%. The AUC is 0.823. The positive predictive value is 85%. The negative predictive value is 70%. Conclusion Ascitic fluid procalcitonin had high sensitivity and specificity in diagnosis of SBP. Procalcitonin is valuable in diagnosis and prognosis of SBP. Procalcitonin is more useful as inflammatory marker than in infections

scholarly journals EVALUATION OF LEUKOCYTE ESTERASE REAGENT STRIPS TEST IN THE DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CHILDREN WITH CIRRHOSIS

2015 ◽  
Vol 52 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Naser HONAR ◽  
Bita GERAMIZADEH ◽  
Seyed-Mohsen DEHGHANI ◽  
Gholamreza KALVANDI ◽  
Iraj SHAHRAMIAN ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Ascitic Fluid ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Rapid Test ◽  
Dipstick Test ◽  
Cross Sectional ◽  
Bacterial Peritonitis ◽  
Strip Test

BackgroundSpontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis.ObjectiveThis study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis.MethodsA single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN ≥250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula.ResultsTotally, 150 ascitic fluid sample of cirrhotic male patients (53.2%) and their mean age (4.33±1.88 years) were analyzed. Biliary atresia (n=44, 29.4%) and idiopathic neonatal hepatitis (n=29, 19.3%) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6%) and distension (64%) were the most common presenting complaint. Of all cases, 41patients (27.35%) were diagnosed to have spontaneous bacterial peritonitis (PMN ≥250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs ≥250mm3 were 87.80% and 91.74%, also on ascitic fluid culture results were 88.23% and 77.44%. Positive predictive value and negative predictive value of this test in PMNs ≥250mm3 were 80% and 95.23% and in cases with positive culture 33.33% and 98.09% were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs ≥250mm3 and culture results were 90.66% and 78.66%.ConclusionThe leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity.

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

The Role of HE4, a Novel Biomarker, in Predicting Optimal Cytoreduction After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 696-702 ◽  
Author(s):  
Francesco Plotti ◽  
Giuseppe Scaletta ◽  
Stella Capriglione ◽  
Roberto Montera ◽  
Daniela Luvero ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Advanced Ovarian Cancer ◽  
Debulking Surgery ◽  
Gynecology And Obstetrics ◽  
Group A ◽  
Group B

ObjectivesThis study aimed to evaluate serum human epididymis protein 4 (HE4) changes during neoadjuvant chemotherapy (NACT) to establish HE4 predebulking surgery cutoff values and to demonstrate that CA125, HE4, and computed tomography (CT) taken together are better able to predict complete cytoreduction after NACT in advanced ovarian cancer patients.MethodsFrom January 2006 to November 2015, patients affected by epithelial advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III–IV), considered not optimally resectable, were included in this prospective study. After 3 cycles of NACT, all patients underwent debulking surgery and were allocated, according to residual tumor (RT), into group A (RT = 0) and group B (RT > 0). Serum CA125, HE4, and CT images were recorded during NACT and compared singularly and with each other in term of accuracy, sensitivity, specificity, and positive and negative predictive value.ResultsA total of 94 and 20 patients were included in group A and group B, respectively. The HE4 values recorded before debulking surgery correlated with RT. The identified HE4 cutoff value of 226 pmol/L after NACT was able to classify patients at high or low risk of suboptimal surgery, with a sensitivity of 75% and a specificity of 85% (positive predictive value, 0.87; negative predictive value, 0.70). The combination of CA125, HE4, and CT imaging resulted in the best combination with a sensitivity of 96% and a specificity of 92% (positive predictive value, 0.96; negative predictive value, 0.94).ConclusionsThe novel biomarker HE4, in addition to CA125 and CT, is better able to predict the RT at debulking surgery and the prognosis of patients.

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 Dynamic Monitoring of sTREM-1 and Other Biomarkers in Acute Cholangitis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Jiahui Jiang ◽  
Xiaolei Wang ◽  
Tongtong Cheng ◽  
Mingyue Han ◽  
Xinxin Wu ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Acute Cholangitis ◽  
Dynamic Monitoring ◽  
Sepsis Group ◽  
Reactive Protein ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background. Sepsis is a common complication of acute cholangitis (AC), which is associated with a high mortality rate. Our study is aimed at exploring the significance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and temperature (T) alone or combined together in early identification and curative effect monitoring of AC with or without sepsis. Methods. 65 consecutive cases with AC and 76 control cases were enrolled. They were divided into three groups: Group A (AC with sepsis), Group B (AC without sepsis), and Group C (inpatients without AC or other infections). The levels of WBC, CRP, PCT, sTREM-1, and temperature were measured dynamically. The study was carried out and reported according to STARD 2015 reporting guidelines. Results. CRP had the highest AUC to identify AC from individuals without AC or other infections (AUC 1.000, sensitivity 100.0%, specificity 100.0%, positive predictive value 100.0%, and negative predictive value 100.0%). Among various single indexes, PCT performed best (AUC 0.785, sensitivity 75.8%, specificity 72.2%, positive predictive value 68.7%, and negative predictive value 78.8%) to distinguish sepsis with AC, while different combinations of indexes did not perform better. From day 1 to day 5 of hospitalization, the levels of sTREM-1 in Group A were the highest, followed by Groups B and C (P<0.05); on day 8, sTREM-1 levels in Groups A and B declined back to normal. However, other index levels among three groups still had a significant difference on day 10. Both in Groups A and B, sTREM-1 levels declined fast between day 1 and day 2 (P<0.05). Conclusions. CRP is the best biomarker to suggest infection here. PCT alone is sufficient enough to diagnose sepsis with AC. sTREM-1 is the best biomarker to monitor patients’ response to antimicrobial therapy and biliary drainage.

scholarly journals ROLE OF USG FINDINGS AS A PREDICTIVE MARKER IN THREATENED ABORTION

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Kamlesh Yadav ◽  
Pragya Ojha
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Predictive Marker ◽  
World Health ◽  
Pregnant Females ◽  
Obstetrics And Gynaecology ◽  
Group A ◽  
Threatened Abortion ◽  
Group B

Background: The Centers for disease control and prevention, and the World Health Organization all define abortion as pregnancy termination before 20 week gestation or with fetus born weighing <500g [1].  Early pregnancy USG parameters: - fetal crown-rump length (CRL), the presence/absence of sub-chorionic hematoma and Fetal Heart Rate (FHR) are good predictors of outcome. Material and Methods: The study was conducted in the Department of Obstetrics and Gynaecology, S.P. Medical College Bikaner& associated Group of Hospital, Bikaner, Rajasthan. This is a hospital based prospective comparative study. The study group comprise of pregnant females attending Obstetrics and Gynaecology OPD. A total of 200 pregnant women are examined in this study. We divided these patients into 2 groups i.e group A and group B. Group A consists of 100 pregnant females with threatened abortion and group B with 100 normal pregnant female. Results: FHR at 115bpm is 76.32% sensitive, 90.32% specific in predicting abortion with 82.86%  positive predictive value and  86.15% negative predictive value.  While CRL at 11 mm is 50% sensitive, 69.35% specific in predicting abortion with 55% positive predictive value and 69.35% negative predictive value.   Conclusion: FHR is best predictive marker followed by presence or absence of sub-chorionic hematoma and CRL  in threatened abortion which results in loss of pregnancy. Keywords: Pregnancy, Abortion, Threatened, USG

Neuromonitoring of the recurrent laryngeal nerve in thyroid gland surgery – results and experiences

2021 ◽  
Vol 70 (2) ◽  
pp. 89-96
Author(s):  
Jiří Hložek ◽  
Jan Rotnágl ◽  
Jaromír Astl
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Laryngeal Nerve ◽  
Operative Strategy ◽  
Predictive Values ◽  
Group A ◽  
Group B ◽  
Neural Monitoring

Paresis of the recurrent laryngeal nerve (RLN) is one of the serious complications of thyroid and parathyroid gland surgery. The intraoperative neural monitoring (IONM) enables to verify the functionality of RLN. The aim of this study is to compare the incidence of postoperative RLN palsy in patients who underwent surgery with and without the use of IONM RLN and to evaluate the positive and negative predictive values, sensitivity, specifi city and accuracy of the method. Methods: Retrospective analysis of thyroid gland surgeries performed within the period from 1. 7. 2016 to 1. 7. 2018. A total of 467 operations were performed (780 nerves exposed). One hundred and thirty procedures (215 nerves) were carried out without IONM (group A). In total, 337 procedures (565 nerves) were performed with IONM (group B). Results: In group A, unilateral postoperative RLN paresis occurred in 7 cases (3.26%); 6 of them were temporary (2.79%) and 1 was permanent (0.47%). In group B, unilateral postoperative RLN paresis occurred in 33 cases (5.84%); 32 of them were temporary (5.66%) and 1 was permanent (0.18%). The incidence of postoperative RLN paresis related to the use of IONM was not considered statistically signifi cant. (Chi-square test: P = 0.146; Fisher‘s exact test: P = 0.2015, P = 0.4715). The sensitivity, specifi city, positive predictive value, negative predictive value and accuracy were 78.79%, 99.25%, 86.67%, 98.69%, and 98.05%, respectively. There was no case of bilateral postoperative RLN paresis. Conclusion: There was no statistically significant diff erence in the incidence of postoperative RLN palsy in patients who underwent surgery with IONM compared to the group without IONM. The high negative predictive value, specifi city and accuracy indicate high reliability of the method. The IONM provides the surgeon with valuable information regarding the functional status of the nerve. This knowledge allows for changing the operative strategy during the procedure. Keywords: intraoperative neural monitoring – IONM – recurrent laryngeal nerve injury – recurrent laryngeal nerve – thyroid surgery

scholarly journals DIATHERMY INCISIONS V/S SURGICAL SCALPEL INCISIONS

2015 ◽  
Vol 22 (11) ◽  
pp. 1550-1524
Author(s):  
Khawar Saeed Jamali ◽  
Naveed Ali Khan ◽  
Muhammad Jawed ◽  
Ubedullah Shaikh
Keyword(s):  
Positive Predictive Value ◽  
General Surgery ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Seroma Formation ◽  
P Value ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: The objective of this study was to compare the outcome of diathermyincisions v/s surgical scalpel incisions in general surgery. Study Design: Cross sectional study.Place and Duration of Study: This study was conducted at surgical unit 7, Sindh Govt. LyariGeneral Hospital and Dow University of Health Sciences between January to December 2009.Methodology: 100 consecutive patients for elective general surgery were randomly assignedto either group A incision with cutting diathermy (n=50) or group B cold steel scalpel (n=50).Data including demographic details, hospital stay, infection rate and non-infective complicationslike swelling, bleeding, dehiscence and seroma formation were recorded in both groups tocompare the final surgical outcome compared. Results: A total of 80 patients were included inthe study, placed alternatively into two groups of 40 patients each with majority being male (n =61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group Awas 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basisof Gender for the two groups, the positive predictive value for male patients of Group A and Bwas 90.09% and 89.28% respectively, but for females the positive predictive value of Group Aand B was 100% and 50% respectively. In Diathermy (Group A) total 20% patients developedcomplications and these were seroma formation (n=4, 8%), wound dehiscence (n=3, 6%) andwound infection (n=3, 6%). In Scalpel (Group B) total 26% patients developed complications(P-value=0.370) in which seromas was noted (n=5, 10%) then wound infection (n=4, 8%), thenwound bleeding (n=3, 6%) and lastly seroma formation (n=1, 2%). Hospital stays were alsoalmost similar with mean value 8.24 days in diathermy group and 10.54 days in scalpel group.No remarkable difference in demographics, characteristics and in other variables of patientswas noted. Conclusion: We conclude that no significant difference in surgical outcome ofboth groups (cutting diathermy Vs. steel scalpel). Therefore, use of either technique to createsurgical wound merely depends upon preference of surgeon.

scholarly journals Role of ascitic fluid adenosine deaminase (ADA) and serum CA-125 in the diagnosis of tuberculous peritonitis

2015 ◽  
Vol 40 (3) ◽  
pp. 89-91 ◽  
Author(s):  
N Ali ◽  
NC Nath ◽  
R Parvin ◽  
A Rahman ◽  
TM Bhuiyan ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Diagnostic Test ◽  
Ascitic Fluid ◽  
Predictive Value ◽  
Ca 125 ◽  
Histopathological Diagnosis ◽  
Diagnostic Modality ◽  
Cross Sectional

This cross sectional study was carried out in the department of gastroenterology, BIRDEM, Dhaka from January 2010 to May 2011 to determine the role of ascitic fluid ADA and serum CA-125 in the diagnosis of clinically suspected tubercular peritonitis. Total 30 patients (age 39.69±21.26, 18M/12F) with clinical suspicion of tuberculosis peritonitis were included in this study after analyzing selection criteria. Laparoscopic peritoneal biopsy with ‘histopathological diagnosis’ was considered gold standard against which accuracics of two biomarkers (ADA & CA-125) were compared. Cut off value of ADA and CA-125 are 24 u/l, 35 U/ml respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ADA as a diagnostic modality in tuberculos peritonitis were 87.5%, 83.33%, 95.45%, 62.5% and 86.67% respectively where as CA-125 was found to have 83.33% sensitivity, 50% specificity, 86.9% positive predictive value, 42.85% negative predictive value and 76.6% accuracy. Both biomarkers are simple, non-invasive, rapid and relatively cheap diagnostic test where as laparoscopy is an invasive procedure, costly & requires trained staff and not without risk and also not feasible in all the centre in our country. So ascitic fluid ADA and serum CA-125 are important diagnostic test for peritoneal tuberculosis.Bangladesh Med Res Counc Bull 2014; 40 (3): 89-91

Sign in / Sign up

Export Citation Format

Share Document