Background: Liver cirrhosis is associated with frequent bacterial infections that increase mortality. Spontaneous bacterial peritonitis (SBP) is an important cause of mortality and morbidity in such patients with ascites. A polymorphonuclear (PMN) cell count >250/μl in the ascitic fluid is the current gold standard for diagnosing SBP which is considered a subjective test. Early diagnosis of SBP although vital is difficult in these patients. Interleukin 6 is pro-inflammatory marker that increases earlier in bacterial infection than other inflammatory markers. This is crucial in cirrhotic patients to initiate treatment accordingly.
Objective: Evaluate the role of IL 6 together with other inflammatory markers in early diagnosis of SBP and as prognostic markers as well.
Patients and methods: The study was conducted on 60 cirrhotic patients with ascites divided into 2 groups. Group I included 30 cirrhotic patients with sterile ascites and group II, 30 patients with SBP. Liver profile, serum creatinine, serum sodium, ascitic IL6 , C-reactive protein, serum pro-calcitonin , and ascitic fluid analysis were done for all patients in both groups. Exclusion criteria included; acute infection, diabetes mellitus, coronary vascular disease, collagen vascular disease and any form of sepsis.
Results: Ascitic IL6 mean value was 2171.5(62.2 – 5000) and 342.5(146 – 2567) pg/ml in groups I and II respectively which was significantly higher in group I than among group II patients (P<0.001). Furthermore, the mean s. procalcitonin was 0.8(0.4-1.1) and 0.4(0.04-0.7) ng/ml among groups In and II respectively and it was significantly higher among the patients with SBP (P<0.001). Diagnosis of SBP among patients with liver cirrhosis could be suggested when ascitic IL6 and serum procalcitonin are assessed at a cut-off values of >780 pg/ml and >0.4ng/ml respectively.
Conclusion: Ascitic IL6 and serum procalcitonin can be used as a valuable surrogate serum marker for early diagnosis of SBP in cirrhotic patients.