Diagnostic Value of Ascitic Fluid Lactoferrin, Calprotectin, and Calprotectin to Albumin Ratio in Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis (SBP) is common and dangerous infection that occurs in 8-27% of cirrhotic inpatients with ascites. In the current study we have demonstrated and compared the diagnostic performance of ascitic fluid lactoferrin and calprotectin in the screening and diagnosis of SBP. In addition we have evaluated ascitic fluid calprotectin to albumin ratio as a novel marker in the diagnosis and Prognosis of SBP. In this cross sectional analytic study, ascitic fluids were collected from 87 cirrhotic patients (49 with SBP and 38 without SBP. Calprotectin and lactoferrin were measured in the ascitic fluids by quantitative sandwich enzyme-linked immunosorbent assay (ELISA). Ascitic fluid calprotectin and lactoferrin were increased significantly in SBP group when compared with non SBP group. Moreover, they were correlated in a positive manner with white blood cells (WBCs) count in ascitic fluid, Polymorphnuclear cells (PMN) count, and serum C-reactive protein (CRP). Also, calprotectin to albumin ratio was increased in SBP cases versus non SBP cases. Moreover, calprotectin to albumin ratio was significantly higher among SBP patients who died inside the hospital than patients with SBP who survived. Both ascitic fluid lactoferrin and calprotectin can be used as valuable markers for diagnosis of SBP. However, ascitic fluid calprotectin is more sensitive and more specific than lactoferrin for diagnosis of SBP. Moreover, calprotectin to albumin ratio in ascites is useful in the diagnosis for SBP as well as it provides prognostic information about the in hospital mortality. K e y w o r d s