Ann Lab Med.  2013 Nov;33(6):449-454. 10.3343/alm.2013.33.6.449.

Procalcitonin and C-Reactive Protein in the Diagnosis and Prediction of Spontaneous Bacterial Peritonitis Associated With Chronic Severe Hepatitis B

Affiliations
  • 1Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, P.R. China. liyan@whu.edu.cn
  • 2Department of Pharmacy, Renmin Hospital, Hubei University of Medicine, Shiyan, P.R. China.

Abstract

BACKGROUND
Procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) are inflammatory markers used to diagnose severe bacterial infections. We evaluated the diagnostic role of these markers and compared their accuracy for spontaneous bacterial peritonitis (SBP) associated with chronic severe hepatitis B (CSHB).
METHODS
PCT and CRP concentrations, WBC count, and other hematological parameters were measured in serum from 84 well-characterized patients with CSHB, of whom 42 had SBP. Receiver operating characteristics (ROC) curve analysis was performed to assess the diagnostic accuracy.
RESULTS
PCT and CRP concentrations were significantly higher in the CSHB patients with SBP (n=42) than CSHB patients without SBP (n=42). PCT and CRP concentrations were more accurate than WBC count for the diagnosis of CSHB-associated SBP. The optimal cutoff value of PCT was 0.48 ng/mL. The PCT concentration was significantly correlated with the CRP concentration and WBC count.
CONCLUSIONS
Serum PCT and CRP seems to be better markers than WBC for the diagnosis of CSHB patients with SBP.

Keyword

Chronic severe hepatitis B; Procalcitonin; C-reactive protein; White blood cell

MeSH Terms

Age Factors
Area Under Curve
Bacterial Infections/complications/*diagnosis
Biological Markers/blood
C-Reactive Protein/*analysis
Calcitonin/*blood
Female
Hepatitis B, Chronic/*complications
Humans
Leukocyte Count
Leukocytes/cytology
Male
Middle Aged
Peritonitis/complications/*diagnosis
Protein Precursors/*blood
ROC Curve
Sex Factors
Temperature
Biological Markers
C-Reactive Protein
Calcitonin
Protein Precursors

Figure

  • Fig. 1 (A) Distribution of the serum concentrations of procalcitonin (PCT) and (B) C-reactive protein (CRP) and (C) white blood cell (WBC) count in chronic severe hepatitis B (CSHB) patients with or without spontaneous bacterial peritonitis (SBP).

  • Fig. 2 ROC curve showing the diagnostic values of PCT, CRP, and WBC for the differentiation between CSHB patients with and without SBP. Areas under the curve were calculated for PCT (AUC, 0.89; 95% CI, 0.81-0.96; sensitivity 95% and specificity 79% at the optimal cutoff of 0.48 mg/L), CRP (AUC, 0.86; 95% CI, 0.78-0.94; 64%/95% at 16.15 mg/L), and WBC (AUC, 0.68; 95% CI, 0.57-0.78; 52%/86% at 8.23×109 cells/L).Abbreviations: AUC, area under the curve; CRP, C-reactive protein; CSHB, chronic severe hepatitis B; PCT, procalcitonin; SBP, spontaneous bacterial peritonitis; WBC, white blood cell.


Reference

1. Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol. 2005; 34:S1–S3. PMID: 16461208.
Article
2. Borzio M, Salerno F, Piantoni L, Cazzaniga M, Angeli P, Bissoli F, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Dig Liver Dis. 2001; 33:41–48. PMID: 11303974.
Article
3. Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008; 28:26–42. PMID: 18293275.
Article
4. Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993; 18:353–358. PMID: 8228129.
Article
5. Thalheimer U, Triantos CK, Samonakis DN, Patch D, Burroughs AK. Infection, coagulation, and variceal bleeding in cirrhosis. Gut. 2005; 54:556–563. PMID: 15753544.
Article
6. Massaro KS, Costa SF, Leone C, Chamone DA. Procalcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infect Dis. 2007; 7:137. PMID: 18034890.
Article
7. Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol. 1999; 19:972–978. PMID: 10195925.
8. Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ. 2000; 321:199–204. PMID: 10903648.
Article
9. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342:836–843. PMID: 10733371.
Article
10. Heney D, Lewis IJ, Evans SW, Banks R, Bailey CC, Whicher JT. Interleukin-6 and its relationship to C-reactive protein and fever in children with febrile neutropenia. J Infect Dis. 1992; 165:886–890. PMID: 1569338.
Article
11. Katz JA, Mustafa MM, Bash RO, Cash JV, Buchanan GR. Value of C-reactive protein determination in the initial diagnostic evaluation of the febrile, neutropenic child with cancer. Pediatr Infect Dis J. 1992; 11:708–712. PMID: 1448309.
Article
12. Engel A, Mack E, Kern P, Kern WV. An analysis of interleukin-8, interleukin-6 and C-reactive protein serum concentrations to predict fever, gram-negative bacteremia and complicated infection in neutropenic cancer patients. Infection. 1998; 26:213–221. PMID: 9717678.
Article
13. Lehrnbecher T, Venzon D, de Haas M, Chanock SJ, Kühl J. Assessment of measuring circulating levels of interleukin-6, interleukin-8, C-reactive protein, soluble Fc gamma receptor type III, and mannose-binding protein in febrile children with cancer and neutropenia. Clin Infect Dis. 1999; 29:414–419. PMID: 10476751.
14. Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H. Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis. 2001; 32:1718–1725. PMID: 11360214.
Article
15. al-Nawas B, Shah PM. Procalcitonin in patients with and without immunosuppression and sepsis. Infection. 1996; 24:434–436. PMID: 9007590.
Article
16. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993; 341:515–518. PMID: 8094770.
Article
17. Gendrel D, Raymond J, Assicot M, Avenel S, Lefèvre H, Ravilly S, et al. Procalcitonin, C-reactive protein and interleukin 6 in bacterial and viral meningitis in children. Presse Med. 1998; 27:1135–1139. PMID: 9767794.
18. Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH, Simon GL, et al. Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab. 1998; 83:3296–3301. PMID: 9745444.
Article
19. Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P, Galani L, Anagnostopoulos N, Grecka P, et al. Potential use of procalcitonin as a diagnostic criterion in febrile neutropenia: experience from a multicentre study. Clin Microbiol Infect. 2004; 10:628–633. PMID: 15214875.
Article
20. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004; 39:206–217. PMID: 15307030.
Article
21. Maruna P, NedelníkováK , Gürlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000; 49:S57–S61. PMID: 10984072.
22. Su DH, Zhuo C, Guan J, Liao K, Cheng WB, Cheng H, et al. Value of serum procalcitonin levels in predicting spontaneous bacterial peritonitis. Hepatogastroenterology. 2013; 60:641–646. PMID: 23159389.
23. Ramsook C, Childers K, Cron SG, Nirken M. Comparison of blood culture contamination rates in a pediatric emergency room: newly inserted intravenous catheters versus venipuncture. Infect Control Hosp Epidemiol. 2000; 21:649–651. PMID: 11083181.
24. Liu Q, Liu Z, Wang T, Wang Q, Shi X, Dao W. Characteristics of acute and sub-acute liver failure in China: nomination, classification and interval. J Gastroenterol Hepatol. 2007; 22:2101–2106. PMID: 18031366.
Article
25. Tandon P, Garcia-Tsao G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis. Semin Liver Dis. 2008; 28:26–42. PMID: 18293275.
Article
26. Thalheimer U, Triantos CK, Samonakis DN, Patch D, Burroughs AK. Infection, coagulation, and variceal bleeding in cirrhosis. Gut. 2005; 54:556–563. PMID: 15753544.
Article
27. 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. PMID: 16310518.
Article
28. Elefsiniotis IS, Skounakis M, Vezali E, Pantazis KD, Petrocheilou A, Pirounaki M, et al. Clinical significance of serum procalcitonin levels in patients with acute or chronic liver disease. Eur J Gastroenterol Hepatol. 2006; 18:525–530. PMID: 16607149.
Article
29. Viallon A, Zeni F, Pouzet V, Lambert C, Quenet S, Aubert G, et al. Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines. Intensive Care Med. 2000; 26:1082–1088. PMID: 11030164.
Article
30. Spahr L, Morard I, Hadengue A, Vadas L, Pugin J. Procalcitonin is not an accurate marker of spontaneous bacterial peritonitis in patients with cirrhosis. Hepatogastroenterology. 2001; 48:502–505. PMID: 11379342.
31. Connert S, Stremmel W, Elsing C. Procalcitonin is a valid marker of infection in decompensated cirrhosis. Z Gastroenterol. 2003; 41:165–170. PMID: 12592597.
32. Papp M, Vitalis Z, Altorjay I, Tornai I, Udvardy M, Harsfalvi J, et al. Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections. Liver Int. 2012; 32:603–611. PMID: 22145664.
Article
33. Viallon A, Zeni F, Pouzet V, Lambert C, Quenet S, Aubert G, et al. Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines. Intensive Care Med. 2000; 26:1082–1088. PMID: 11030164.
Article
34. Runyon BA. Ascitic fluid and serum C-reactive protein concentrations in patients with and without peritonitis. Am J Clin Pathol. 1986; 86:773–775. PMID: 3788865.
Article
35. Tsiakalos A, Karatzaferis A, Ziakas P, Hatzis G. Acute-phase proteins as indicators of bacterial infection in patients with cirrhosis. Liver Int. 2009; 29:1538–1542. PMID: 19659507.
Article
36. Lin ZY, Chuang WL, Dai CY, Yu ML, Chen SC, Hsieh MY, et al. Clinical application of serum C-reactive protein measurement in the detection of bacterial infection in patients with liver cirrhosis. Kaohsiung J Med Sci. 2002; 18:121–126. PMID: 12149826.
37. Li CH, Yang RB, Pang JH, Chang SS, Lin CC, Chen CH, et al. Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department. Acad Emerg Med. 2011; 18:121–126. PMID: 21276124.
Article
Full Text Links
  • ALM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr