الفهرس | Only 14 pages are availabe for public view |
Abstract Spontaneous bacterial peritonitis (SBP) is a common and severe complication in cirrhotic patients with ascites which occurs in 10-30% of patients with cirrhotic ascites admitted to hospitals with amortality rate ranging between 30-50% mainly due to renal failure. The diagnosis of SBP is made when the polymorph nuclear leukocyte(PMNL) count in ascitic fluid is greater than 250 cells per cubic millimeter. This prospective case-control study was performed to evaluate tumor necrosis factor-α (TNF-α) and Interleukin-6 (IL-6) in patients with spontaneous bacterial peritonitis (SBP) and sterile ascites due to liver cirrhosis admitted to Internal Medicine inpatient wards of Ain shams university hospitals. Twenty patients within group 1 (cirrhotic patients with SBP) and 20 patients within group 2 (cirrhotic patients with ascites without evidence of SBP) were included,and 10 healthy as control. The mean age of SBP group was similar to the mean age of the sterile group. All were presenting with cirrhotic ascites according to clinical, laboratory and ultrasonic criteria regardless to the presence or absence of clinical evidence of SBP. All patients included in this study were subjected to history taking, physical examination, laboratory tests including; complete blood count, liver function, prothrombin time, serum creatinine and serum TNF-α and IL-6, and abdominal ultrasound and ascitic fluid examination which included cell count, total proteins and TNF-α and IL-6. There were no statistically significant differences between septic and aseptic groups regarding all socio-demographic characteristics including; age, gender, residence, occupation, marital status, educational level and smoking history (p>0.05). There were no statistically significant differences between septic and aseptic groups regarding all complaints (p>0.05); except for fever. SBP group had significantly higher prevalence of fever than sterile group (70% versus 20%, respectively) (p<0.01). The percentage of abdominal pain or discomfort was higher in SBP group than in sterile group (70% versus 40%, respectively) with nearly significant p-value (p=0.056). There were no statistically significant differences between septic and aseptic groups regarding etiology and duration of liver disease (p>0.05). There was no statistically significant differences between septic and aseptic groups regarding past history of abdominal paracentesis (p>0.05). The percentage of patients with previous abdominal paracentesis was 65% in SBP group and 55% in sterile group (p>0.05), also there was no statistically significant differences between septic and aseptic groups regarding past history of pervios attack of SBP was 15% in SBP group and10% in sterile group (p>0.05). SBP group had significantly higher prevalence of abdominal tenderness than sterile group (70% versus 40%, respectively) with nearly significant p-value (p=0.056). There were no statistically significant differences between the first and the second groups regarding all laboratory findings of ascitic fluid (p>0.05). We have found that ascitic TNF-α, serum TNF-α and ascitic IL-6, serum IL-6, were higher among patients with SBP than patients without SBP . In conclusion, ascitic TNF-α, serum TNF-α and ascitic IL- 6,serum IL-6 are significant dependent predictors for SBP in patients with advanced CLD and recommend for ascitic and serum sample could obtained for the patients admitted in the hospital with cirrhosis with ascitis, and examination of these samples for levels of TNF&IL-6, for early prediction of SBP to avoid comlication. |