Vol. 12 No. 1 (2020): Archives of Public Health
Clinical Science

Quantitative determination of calprotectin in ascites in patients with spontaneous bacterial peritonitis

Fana Lichoska-Josifovikj
University Clinic of Gastroenterohepatology, Medical Faculty, Skopje, Republic of North Macedonia
Meri Trajkovska
University Clinic of Gastroenterohepatology, Medical Faculty, Skopje, Republic of North Macedonia
Kalina Grivceva-Stardelova
University Clinic of Gastroenterohepatology; Medical Faculty, Skopje, Republic of North Macedonia
Viktoria Caloska-Ivanovska
University Clinic of Gastroenterohepatology; Medical Faculty, Skopje, Republic of North Macedonia
Rozalinda Popova-Jovanovska
University Clinic of Gastroenterohepatology; Medical Faculty, Skopje, Republic of North Macedonia
Lidija Petkovska
University Clinic of Toxicology; Medical Faculty, Skopje, Republic of North Macedonia
Emilija Petrovska
Institute of Clinical Biochemistry, Medical Faculty, Skopje, Republic of North Macedonia
Sefedin Biljali
Institute of Clinical Biochemistry; Medical Faculty, Skopje, Republic of North Macedonia

Published 2020-02-18

Keywords

  • calprotectin,
  • spontaneous bacterial peritonitis,
  • liver cirrhosis

How to Cite

1.
Личоска-Јосифовиќ Ф, Трајковска М, Гривчева-Старделова К, Чалоска-Ивановска В, Попова-Јовановска Р, Петковска Л, Петровска Е, Билјали С. Quantitative determination of calprotectin in ascites in patients with spontaneous bacterial peritonitis. Arch Pub Health [Internet]. 2020 Feb. 18 [cited 2022 Jan. 19];12(1):23-32. Available from: https://id-press.eu/aph/article/view/4475

Abstract

Spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis is a newly developed, spontaneous bacterial infection of sterile ascites fluid, in the absence of intraabdominal sources of infection or malignancy. The most sensitive indicator of diagnosis is when the polymorphonuclear cell count (PMNC) is ≥250 in 1 ml ascites fluid (manual microscopic or automated counting) and/or when a bacterial strain is isolated in microbiological culture. The objectives of our pilot study were to determine the concentration of calprotectin in ascites in patients with SBP and non-SBP with BíœHLMANN Quantum Blue®Reader, whether there was a significant difference between the average values "‹"‹of Turcotte-Pugh II and MELD score and to determine average values for CRP serum and ascites in the studied groups. Materials and methods. This prospective analytical observational pilot study included 30 patients with liver cirrhosis and ascites, divided into two groups, SBP and non-SBP. The quantitative measurement of calprotectin in ascites was performed with the Quantum Blue Calprotectin Ascites (LF-ASC25) test. The test is designed to selectively measure calprotectin antigen (MRP8/14) with direct sandwich immunoassay. The ascites samples were diluted with Chase Buffer 1:5 and after 12 minutes incubation at room temperature, the test line signal intensity and the control line were quantitated with BíœHLMANN Quantum Blue®Reader. The collected data were processed using the SPSS 23 statistical software for Windows. Results. In our study the average value of calprotectin in patients with SBP was 1.4 µg/mL. The lowest value of calprotectin in the study group was recorded in one patient at 0.61 µg/mL, while the highest value was 1.81 µg/mL in four patients. The results showed higher values "‹"‹of calprotectin in ascites in patients with alcoholic liver disease compared to other etiologies. Refractive ascites was reported in 60.0% of the subjects and only one patient (6.7%)was reported with Klepsiella pneumoniae in the microbiological analysis of ascites. According to the Child-Turcotte-PughII classification, all patients in the study group were class C, while the mean MELD score was 29.8±6.14. The difference between the average values of CRP in serum and ascites in patients with SBP was statistically significant compared to non-SBP. Conclusion. The quantitative determination of calprotectin in ascites by the Quantum Blue Calprotectin Ascites (LF-ASC25) assay can be used as an alternative to the determination of PMNC in ascites. SBP occurs in patients with severe hepatic dysfunction calculated according to the Child-Pugh II score and the MELD score. Serum and ascites C-reactive protein values were not significantly elevated in patients with SBP, but were significantly different from non-SBP patients.

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References

  1. Rimola A, Garcí­a-Tsao G, Navasa M, Piddock LJ, Planas R, Bernard B, Inadomi JM. Diagnosis,treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000;32:142-53.
  2. Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: recent guidelines and wider. Gut 2012;61: 297-310.
  3. Dever JB, Sheikh MY. Review article: spontaneous bacterial peritonitis-bacteriology, diagnosis, treatment, risk factors and prevention. Aliment Pharmacol Ther 2015;41:1116–1131.
  4. Conn HO. Spontaneous peritonitis and bacteremia in laennec's cirrhosis caused by enteric organisms. A relatively common but rarely recognized syndrome. Ann Intern Med 1964;60:568-80.
  5. Oliveira AM, Branco JC, Barosa R, Rodrigues JA, Ramos L, Martins A, Karvellas CJ, Cardoso FS. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study. Eur J Gastroenterol Hepatol 2016;28:1216–1222.
  6. Oladimeji AA, Temi AP, Adekunle AE, Taiwo RH, Ayokunle DS. Prevalence of spontaneous bacterial peritonitis in liver cirrhosis with ascites. Pan Afr Med J 2013;15:128.
  7. Bal CK, Daman R, Bhatia V. Predictors of fifty days in-hospital mortality in decompensated cirrhosis patients with spontaneous bacterial peritonitis. World J Hepatol 2016;8:566–572.
  8. Fernández J, Navasa M, Gómez J, Colmenero J, Vila J, Arroyo V, Rodés J. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35: 140-148.
  9. Wiest R, Rath HC. Gastrointestinal disorders of the critically ill. Bacterial translocation in the gut. Best Pract Res Clin Gastroenterol2003; 17: 397-425.
  10. Ruiz-del-Arbol L, Urman J, Fernández J, González M, Navasa M, Monescillo A, Albillos A,Jiménez W, Arroyo V. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 2003;38(5):1210-8.
  11. Berg RD. Mechanisms promoting bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol 1999; 473: 11-30.
  12. Guarner C, Soriano G. Bacterial translocation and its consequences in patients with cirrhosis. Eur J Gastroenterol Hepatol 2005; 17: 27-31
  13. Moore K. Spontaneous bacterial peritonitis (SBP). In Warrel DA et al. Oxford Textbook of Medicine, 4th Edition, Oxford University Press 2003, Vol 2, sections 11-17, 739-741
  14. Jalan R, Fernandez J, Wiest R, et al. Bacterial infections in cirrhosis:a position statement based on the EASL. J Hepatol 2014;60(6):1310–1324.
  15. Wiest R, Krag A, Gerbes A.Spontaneous bacterial peritonitis: recent guidelines and wider. Gut2012;61: 297-310.
  16. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. World J Hepatol 2010; 53: 397–417.
  17. Runyon BA, AASLD. American association for the study of liver diseases practice guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57: 1651 –3.
  18. Shizuma T. Diagnostic Laboratory Markers for Spontaneous Bacterial Peritonitis. Ann Clin Lab Res. 2016, 4: 4.
  19. Di Martino V, Weil D, Cervoni JP, Thévenot T. New prognostic markers in liver cirrhosis. World J Hepatol 2015; 7: 1244–50.
  20. Koutsounas I, Kaltsa G, Siakavellas SI, Bamias G.Markers of bacterial translocation in end-stage liver disease.World J Hepatol 2015; 7(20): 2264-2273
  21. BurriE,SchulteF,MuserJ,MeierR,BeglingerC.Measurement of calprotectin in ascitic fluid to identify elevated polymorphonuclear cell count. World J Gastroenterol 2013; 19: 2028–36.
  22. Abdel-Razik A, Mousa N, Elhammady D, Elhelaly R, Elzehery R, Elbaz S, Eissa M, El-Wakeel N, Eldars W. Ascitic Fluid Calprotectin and Serum Procalcitonin as Accurate Diagnostic Markers for Spontaneous Bacterial Peritonitis. Gut Liver 2016;10:624–631.
  23. Bota DP, Van Nuffelen M, Zakariah AN, Vincent JL. Serum levels of C-reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver. J Lab Clin Med 2005; 146: 347-351
  24. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P,Naess-Andresen CF, Dale I. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol 1997; 50:113-123
  25. Heikla A, El-Nokeetya M, Roshdya E, Moheyb A.Ascitic calprotectin as a diagnostic marker for spontaneous bacterial peritonitis in hepatitis C virus cirrhotic Egyptian patients. The Egiptian J Int Med 2018; 30(1):1-7
  26. Homann C, Garred P, Graudal N, Hasselqvist P, Christiansen M,Fagerhol MK, Thomsen AC. Plasma calprotectin: a new prognostic marker of survival in alcohol-induced cirrhosis. Hepatology 1995; 21: 979-985
  27. Nacken W, Roth J, Sorg C, Kerkhoff C. S100A9/S100A8: Myeloid representatives of the S100 protein family as prominent players in innate immunity. Microsc Res Tech 2003; 60: 569-580
  28. Roseth AG, Schmidt PN, Fagerhol MK. Correlation between faecalexcretion of indium-111-labelled granulocytes and calprotectin, a granulocyte marker protein, in patients with inflammatory bowel disease. Scand J Gastroenterol 1999;34:50-4.
  29. Lutz P, Pfarr K, Nischalke HD, Krämer B, Goeser F, GlässnerA, et al. The ratio of calprotectin to total protein as a diagnostic and prognostic marker for spontaneous bacterial peritonitis in patients with liver cirrhosis and ascites. Clin Chem and Lab Med (CCLM) 2015; 53(12): 2031–2039
  30. Fernandes SR, Santos P, Fatela N, Baldaia C,Marinho RT, ProencíŸa H, Ramalho F. Ascitic Calprotectin is a Novel and Accurate Marker for Spontaneous Bacterial Peritonitis. J Clin Lab Anal 2016; 30:1139–1145
  31. Heikl AA, El-Nokeety MM, Roshdy E, Mohey A. Ascitic calprotectin as a diagnostic marker for spontaneous bacterial peritonitis in hepatitis C virus cirrhotic Egyptian patients. Egypt J Intern Med 2018;30:1-7
  32. Homann C, Christensen E, Schlichting P, Philipsen EK, Graudal NA, Garred P. Ascites fluid and plasma calprotectin concentrations in liver disease. Scand J Gastroenterol 2003; 38: 415-420
  33. Montalto M, Gallo A, Ferrulli A, Visca D, Campobasso E, Cardone S, et al. Fecal calprotectin concentrations in alcoholic patients: a longitudinal study. Eur J Gastroenterol Hepatol 2011; 23: 76-80
  34. Johne B, Fagerhol MK, Lyberg T, Prydz H, Brandtzaeg P,Naess-Andresen CF, Dale I. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol 1997; 50(3):113-23.
  35. Gundling F, Schmidtler F, Hapfelmeier A, Schulte B, Schmidt T,Pehl C, et al. Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis. Liver Int 2011; 31: 1406-1415
  36. Alempijević T, Štulić M, Popovic D, Culafic D, Dragasevic S, Milosavljevic T. The role of fecal calprotectin in assessment of hepatic encephalopathy in patients with liver cirrhosis. Acta Gastroenterol Belg 2014; 77: 302-305
  37. Weil D, Heurgue-Berlot A, Monnet E, Chassagne S, Cervoni J.P, Feron T, et al. Accuracy of calprotectin using the Quantum Blue Reader for the diagnosis of spontaneous bacterial peritonitis in liver cirrhosis. Hepatology Research 2018 doi: 10.1111/hepr.13239
  38. Burri E, Felix Schulte, Muser J, Meier R, BeglingerCh. Measurement of calprotectin in ascitic fluid to identify elevated polymorphonuclear cell count.World J Gastroenterol 2013; 19(13):2028-2036
  39. Johne B, Fagerhol MK, Lyberg T, et al. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol 1997;50(3):113–123.
  40. Korndorfer IP, Brueckner F, Skerra A. The crystal structure of the human (S100A8/S100A9)2 heterotetramer, calprotectin, illustrates how conformational changes of interacting alpha-helices can determine specific association of two EF-hand proteins. J Mol Biol 2007;370(5):887–898.
  41. Fagerhol MK. Nomenclature for proteins: is calprotectin a proper name for the elusive myelomonocytic protein? Clin Mol Pathol 1996;49(2):M74–M79.
  42. Dale I, Brandtzaeg P, Fagerhol MK, Scott H. Distribution of a new myelomonocytic antigen (LI) in human periferal blood leukocytes. Am J Clin Pathol 1985;84:24-34.
  43. Johne B, Fagerhol MK, Lyberg T, et al. Functional and clinical aspects of the myelomonocyte protein calprotectin. Mol Pathol 1997;50(3):113–123.
  44. Andersson KB, Sletten K, Berntzen HB, Dale I, Brandtzaeg P, Jellum E, Fagerhol MK. The leucocyte L1 protein: identity with the cystic fibrosis antigen and the calcium-binding MRP-8 and MRP-14 macrophage components. Scand J Immunol 1988; 28(2): 241-5.
  45. Jung GE, Encke J, Schmidt J, Rahmel A. Model for end-stage liver disease. Der Chirurg 2008;79 (2): 157–63.
  46. Angermayr B, Cejna M, Karnel F, Gschwantler M, Koenig F, Pidlich J, et al. Child-Pughversus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt. Gut 2003;52(6):879-8