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Journal of Paediatrics and Child Health Jan 2023
Topics: Infant, Newborn; Humans; Ascitic Fluid; Liver Cirrhosis; Peritonitis
PubMed: 36222293
DOI: 10.1111/jpc.16243 -
BMC Pediatrics Jun 2022The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence...
BACKGROUND
The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis.
MATERIALS AND METHODS
In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA.
RESULTS
Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease.
CONCLUSION
Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN.
Topics: Ascites; Ascitic Fluid; Bacterial Infections; Biomarkers; Child; Humans; Leukocyte L1 Antigen Complex; Liver Cirrhosis; Peritonitis
PubMed: 35773636
DOI: 10.1186/s12887-022-03433-9 -
Journal of Clinical Gastroenterology Mar 1994A large number of ascitic fluid tests, e.g., fibronectin and cholesterol, have been proposed as helpful in detecting malignancy as the cause of ascites. Unfortunately,... (Review)
Review
A large number of ascitic fluid tests, e.g., fibronectin and cholesterol, have been proposed as helpful in detecting malignancy as the cause of ascites. Unfortunately, these "humoral tests of malignancy" are nonspecific. Although the ascitic fluid concentrations of these proteins or protein-bound substances tend to be quite high in patients with peritoneal carcinomatosis and low in the setting of cirrhotic ascites, the problem is that patients with tuberculous peritonitis, cardiac ascites, pancreatitis ascites, etc. usually have values in the malignancy range, i.e., false-positive results. This can lead to an extensive search for a nonexistent tumor, with confusion and anxiety for patient and physician. The cytology is the single best test to order when peritoneal carcinomatosis is suspected; its sensitivity approaches 100%. However, peritoneal carcinomatosis is only one of several mechanisms by which tumors can cause ascites. No one test can be expected to detect tumors as the cause of these diverse mechanisms of ascites formation. The serum-ascites albumin gradient is a helpful test in classifying ascitic fluid specimens into portal-hypertension-related and non-portal-hypertension-related categories. An elevated serum alpha-fetoprotein test can be useful in raising suspicion of hepatocellular carcinoma. Careful analysis of ascitic fluid, without measurement of "humoral tests of malignancy," combined with information obtained from the history and physical examination, usually lead to an accurate diagnosis of the cause of ascites.
Topics: Ascites; Ascitic Fluid; Biomarkers, Tumor; Humans; Neoplasms; Sensitivity and Specificity
PubMed: 8189030
DOI: 10.1097/00004836-199403000-00002 -
Anti-inflammatory & Anti-allergy Agents... 2021Spontaneous bacterial peritonitis is a common bacterial infection of ascitic fluid, mainly in ascites due to liver cirrhosis. Mannose-binding lectin (MBL) can activate...
BACKGROUND
Spontaneous bacterial peritonitis is a common bacterial infection of ascitic fluid, mainly in ascites due to liver cirrhosis. Mannose-binding lectin (MBL) can activate phagocytosis and the complement system. Spontaneous bacterial peritonitis was detected to be higher in MBL deficiency. This study aimed to assess ascitic fluid MBL in liver cirrhosis and spontaneous bacterial peritonitis.
METHODS
Ninety patients with cirrhotic ascites were included. Forty five of them had SBP. Child- Pugh score, Model for End Stage Liver Disease (MELD) and its update (uMELD) scores were used to assess the severity of liver cirrhosis. Ascitic fluid samples were obtained for differentiation of leucocytic count, estimation of albumin, protein, glucose, and serum-ascitic albumin gradient. Ascitic fluid levels of MBL were measured for all patients. SBP was documented if polymorphonuclear leucocytic count ≥250/mm in ascitic fluid.
RESULTS
Ascitic fluid MBL level was significantly lower in patients with SBP. MBL had a significant negative correlation with ascitic total leukocytic count (TLC), also with serum creatinine, bilirubin, PT, INR and MELD score among SBP patients. However, it had a significant positive correlation with ascitic protein and with platelets. According to multivariate analysis, fever, TLC, platelets, creatinine, MBL, glucose and polymorphs were independent predictors for SBP development.
CONCLUSION
Ascitic fluid MBL could be a good predictive and prognostic marker in patients with cirrhosis and spontaneous bacterial peritonitis.
Topics: Adult; Ascitic Fluid; Female; Humans; Liver Cirrhosis; Male; Mannose-Binding Lectin; Middle Aged; Peritonitis
PubMed: 32552645
DOI: 10.2174/1871523019666200617132513 -
The Netherlands Journal of Medicine Oct 1993An accumulation of peritoneal fluid can result from a variety of conditions, cirrhosis of the liver being responsible for about 75% of all patients with ascites.... (Review)
Review
An accumulation of peritoneal fluid can result from a variety of conditions, cirrhosis of the liver being responsible for about 75% of all patients with ascites. Malignancy accounts for 10-12% and cardiac failure for about 5%. The remaining 8-10% of ascites cases have a variety of causes, including tuberculosis, pancreatic disease and kidney disease. An early and accurate diagnosis often depends on an appropriate ascitic fluid analysis. Patients with known liver cirrhosis and clinical deterioration also need to have a paracentesis, with a determination of the ascitic fluid leukocyte and neutrophil count and adequate bacteriological cultures of their ascitic fluid. The diagnostic value of different ascitic fluid parameters and their ability to distinguish between several aetiologies and their complications, is discussed.
Topics: Ascites; Ascitic Fluid; Humans; Hydrogen-Ion Concentration; Leukocyte Count; Neutrophils; Punctures; Suction
PubMed: 8302393
DOI: No ID Found -
Hepatology (Baltimore, Md.) 1988A prospective study identified 45 patients with malignancy-related ascites among 448 ascites patients (10% of the total). Patients were categorized into five subgroups...
A prospective study identified 45 patients with malignancy-related ascites among 448 ascites patients (10% of the total). Patients were categorized into five subgroups based on the pathophysiology of ascites formation. Each subgroup had a distinctive ascitic fluid analysis. Patients with peritoneal carcinomatosis but without massive liver metastases (53.3% of the patients with malignancy-related ascites) had a uniformly positive ascitic fluid cytology, high ascitic fluid protein concentration and low serum-ascites albumin gradient. Patients with massive liver metastases and no other cause for ascites formation (13.3% of the series) had a negative cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Those with peritoneal carcinomatosis and massive liver metastases (13.3% of the series) had a nearly uniformly positive ascitic fluid cytology, variable protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Chylous ascites (6.7%) was characterized by a milky appearance, negative cytology and an elevated ascitic fluid triglyceride concentration. Patients with hepatocellular carcinoma superimposed on cirrhosis (13.3%) had negative ascitic fluid cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and elevated serum and ascitic fluid alpha-fetoprotein concentration. Two-thirds of patients with malignancy-related ascites had peritoneal carcinomatosis; 96.7% of patients with peritoneal carcinomatosis had positive ascitic fluid cytology. Ascitic fluid analysis is helpful in identifying and distinguishing the subgroups of malignancy-related ascites.
Topics: Alkaline Phosphatase; Ascites; Ascitic Fluid; Chylous Ascites; Humans; Liver Neoplasms; Neoplasm Proteins; Neoplasms; Peritoneal Neoplasms; Prospective Studies; Serum Albumin
PubMed: 3417231
DOI: 10.1002/hep.1840080521 -
Lancet (London, England) Mar 1996
Topics: Ascites; Ascitic Fluid; Heart Failure; Humans; Proteins
PubMed: 8602043
DOI: 10.1016/s0140-6736(96)90131-2 -
Gastroenterologie Clinique Et Biologique Mar 1998
Review
Topics: Antibiotic Prophylaxis; Ascitic Fluid; Bacterial Infections; Clinical Trials as Topic; Humans; Quinolones; Risk Factors
PubMed: 9762215
DOI: No ID Found -
Gastroenterology Jan 1990The analysis of ascitic fluid has been complicated by several recently reported new tests. To simplify this assessment, we evaluated nine parameters prospectively and... (Comparative Study)
Comparative Study
The analysis of ascitic fluid has been complicated by several recently reported new tests. To simplify this assessment, we evaluated nine parameters prospectively and simultaneously in blood and ascitic fluid from 285 patients with ascites to determine which were the most reliable for immediate diagnosis of the etiology of the ascites and of its complications. Subjects were first divided into four groups: sterile cirrhotic ascites (n = 201), spontaneous bacterial peritonitis (n = 41), malignant ascites (n = 34), and miscellaneous ascites (n = 9). An ascitic fluid polymorphonuclear count greater than 500/microliters was the test with the greatest accuracy (96%) for the diagnosis of spontaneous bacterial peritonitis. Neither the most precise cutoff values for ascitic fluid pH (less than 7.32) and ascitic fluid lactate (greater than 32 mg/dl), nor their respective blood-ascitic fluid gradients (greater than 0.11 and less than -20 mg/dl) were more reliable indexes of spontaneous bacterial peritonitis, mainly due to the decreased ascitic fluid pH and increased ascitic fluid lactate observed in malignant ascites, tuberculous peritonitis, and pancreatic ascites. A blood-ascitic fluid albumin gradient less than 1.1 g/dl was the most accurate parameter for the diagnosis of malignant ascites (diagnostic efficacy, 93%). Therefore, the etiologic analysis of ascitic fluid might be simplified and the single practice of two tests, ascitic fluid polymorphonuclear cell count and blood-ascitic fluid albumin gradient, provides immediately useful information.
Topics: Adult; Aged; Ascitic Fluid; Bacterial Infections; Female; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Peritonitis; Prospective Studies; Serum Albumin
PubMed: 2293572
DOI: 10.1016/0016-5085(90)91301-l -
Asia-Pacific Journal of Clinical... Apr 2021Neutrocytic ascites, traditionally defined as a polymorphonuclear neutrophil count ≥250/mm , is infrequently reported during paracenteses to relieve malignant ascites...
Discrimination of ascitic fluid infection in malignant ascites by polymorphonuclear neutrophil ratio and count: Investigating the validity of count ≥250/mm as the one-size-fits-all criterion.
AIM
Neutrocytic ascites, traditionally defined as a polymorphonuclear neutrophil count ≥250/mm , is infrequently reported during paracenteses to relieve malignant ascites (MA). This study aims to explore new potential diagnostic criteria to discriminate ascitic fluid infection associated with MA and to examine the clinical and laboratory characteristics of neutrocytic ascites.
METHODS
The investigators retrospectively collected data on paracenteses to relieve MA at the Emergency Department of National Cancer Center, Korea, from January 2014 to February 2017. We analyzed the patients whose ascites fulfilled the traditional criteria for classification as neutrocytic ascites; polymorphonuclear neutrophils ≥250/mm with no history of either hepatocellular carcinoma or liver cirrhosis.
RESULTS
In total, 1467 patients underwent paracentesis to relieve MA. Excluding 98 follow-up paracenteses cases, 112 cases (8.2%) showed neutrocytic ascites. Of these 112 patients, 27 (24.1%) had positive culture results. Receiver-operating characteristic analysis indicated that the area under the curve (AUC) values were 0.90 (95% CI 0.82-0.95) and 0.86 (95% CI 0.78-0.92) for polymorphonuclear neutrophil ratio and count, respectively. The difference between the two AUCs was not statistically significant (P = .29). Moreover, the best cutoff points were 70% and 1500/mm for polymorphonuclear neutrophil ratio and count, respectively. In addition, extensive liver metastasis was a significant independent risk factor of MA associated with ascitic fluid infection.
CONCLUSIONS
Both polymorphonuclear neutrophil ratio and count had good discriminative abilities for culture results in MA. Polymorphonuclear neutrophil ratio was somewhat better despite lacking statistical significance compared to polymorphonuclear neutrophil count, with 70% as best cutoff.
Topics: Ascites; Ascitic Fluid; Female; Humans; Male; Middle Aged; Neutrophils; Retrospective Studies
PubMed: 32762145
DOI: 10.1111/ajco.13344