Diagnostic and Prognostic Value of Ascitic Prostaglandin E2 in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is frequent in cirrhosis and represents the most
common cause of hospitalization. Despite progress in their pathogenesis, prevention and management,
bacterial infections still remain a cause of mortality and admission to intensive care units. This study
is aimed to detect the role of ProstaglandinE2 (PGDE2) in serum and ascetic fluid as a diagnostic
marker for eradication of SBP. Patients and methods: A prospective cohort study involved patients
with liver cirrhosis, ascites and spontaneous bacterial peritonitis referred to the Internal Medicine,
Faculty of Medicine, Zagazig University. Patients with ascites divided into 2 groups: case group (26
cirrhotic patients with SBP) ,control group (26 cirrhotic patients without SBP). All patients were
subjected to a thorough history and complete clinical examination. White blood cell and
Polymorphonuclear cells (PMN) counts in peripheral blood; PMN counts, protein, glucose in ascitic
fluid and PGDE2 before and after five days of treatment were estimated. Results: Serum and ascitic
PGDE2 was elevated in all cirrhotic groups either case and control more than normal. However,
PGDE2 level was lower in case group before treatment in comparsion with control group, and after
treatment PGDE2 levels was elevated. There is statistically significant change in PMN after treatment.
The best cutoff of ascitic fluid PGDE2 in diagnosis of SBP among ascitic patients is ≤ 750.512 with
area under curve 0.71, sensitivity 76.9%, specificity 61.5% , positive predictive value 66.7%, negative
predictive value 72.7%, accuracy 69.2% (p<0.05). Regarding performance of serum PGDE2, ROC
curve showing area under curve 0.781, sensitivity 76.9%, specificity 76.9%. There is statistically
significant positive correlation between ascitic fluid prostaglandin E2 before treatment and serum
prostaglandin E2 before treatment. Conclusion: Prostaglandin E2 as acute phase reactant increased in
patient with SBP. Serum or ascitic ProstaglandinE2 was high in SBP and declined in patients
responding to antibiotic treatment. PMN counts in peripheral blood didn’t decrease in response to
antibiotic treatment of SBP.