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Int J Med Sci 2013; 10(10):1367-1374. doi:10.7150/ijms.6014 This issue Cite

Research Paper

The Role of Serum Procalcitonin Levels in Predicting Ascitic Fluid Infection in Hospitalized Cirrhotic and Non-cirrhotic Patients

Yesim Cekin¹, Ayhan Hilmi Cekin^2✉, Adil Duman², Ustun Yilmaz³, Bayram Yesil³, Basak Oguz Yolcular⁴

1. Department of Microbiology, Antalya Training and Research Hospital, Antalya, Turkey.
2. Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey.
3. Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
4. Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine Antalya, Turkey.

✉ Corresponding author: Dr.Ayhan Hilmi Cekin, Uluc Mah., 24. Cadde 1164 Sok. Sefik Aker Sitesi B Blok Daire: 10, Konyaalti, Antalya. Phone: +90 532 361 48 71 Fax: +90 242 238 58 48 E-mail: ayhancekincom.

Abstract

Objective: To determine the role of serum procalcitonin levels in predicting ascites infection in hospitalized cirrhotic and non-cirrhotic patients.

Methods: A total of 101 patients (mean age: 63.4±1.3, 66.3% were males) hospitalized due to cirrhosis (n=88) or malignancy related (n=13) ascites were included in this study. Spontaneous bacterial peritonitis (SBP, 19.8%), culture-negative SBP (38.6%), bacterascites (4.9%), sterile ascites (23.8%) and malign ascites (12.9%) groups were compared in terms of procalcitonin levels in predicting ascites infection. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of procalcitonin levels and predicting outcome of procalcitonin levels was compared with C-reactive protein (CRP).

Results: Culture positivity was determined in 26.7% of overall population. Serum procalcitonin levels were determined to be significantly higher in patients with positive bacterial culture in ascitic fluid compared to patients without culture positivity (median (min-max): 4.1 (0.2-36.4) vs. 0.4 (0.04-15.8), p<0.001). Using ROC analysis, a serum procalcitonin level of <0.61 ng/mL in SBP (area under curve (AUC): 0.981, CI 95%: 0.000-1.000, p<0.001), <0.225 ng/mL in culture-negative SBP (AUC: 0.743, CI 95%: 0.619-0.867, p<0.001), <0.42 ng/mL in SBP and culture-negative SBP patients (AUC: 0.824, CI 95%: 0.732-0.916, p<0.001), and <1.12 ng/mL in bacterascites (AUC: 0.837, CI 95%: 0.000-1.000, p=0.019) were determined to accurately rule out the diagnosis of bacterial peritonitis. Predictive power of serum procalcitonin levels in SBP + culture-negative SBP group (AUCs: 0.824 vs 0.622, p=0.004, Fig 4), culture-positive SBP (AUCs: 0.981 vs 0.777, p=0.006, Fig 5) and (although less powerfull) in culture-negative SBP (AUCs: 0.743 vs 0.543, p=0.02, Fig 6) were found significantly higher than CRP.

Conclusion: According to our findings determination of serum procalcitonin levels seems to provide satisfactory diagnostic accuracy in differentiating bacterial infections in hospitalized patients with liver cirrhosis related ascites.

Keywords: Procalcitonin, ascitic fluid infection, hospitalized patients, cirrhosis, malignancy, cut-off value.

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