High sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites.

BACKGROUND/AIMS: Diagnosis of spontaneous bacterial peritonitis in cirrhotic ascites is based on a polymorphonuclear leukocyte count of ascitic fluid equal or greater than 250/mm3 in the presence of clinical signs. There is a small number of patients with positive ascitic fluid culture whose polymorphonuclear leukocyte count is less than 250/mm3. In this study, we assessed the diagnostic value of serum high sensitivity C-reactive protein in spontaneous bacterial peritonitis with nonneutrocytic ascites. METHODOLOGY: Patients with decompensated cirrhosis were enrolled in three groups. Group 1: Signs and symptoms of peritonitis plus a polymorphonuclear leukocyte count of ascitic fluid equal or greater than 250/mm3. Group 2: Signs and symptoms of peritonitis, but polymorphonuclear leukocyte count of ascitic fluid less than 250/mm3. Group 3: No signs and symptoms of peritonitis and polymorphonuclear leukocyte count of ascitic fluid less than 250/mm3. Ceftriaxone was started in Groups 1 and 2. Serum level of hsCRP was repeated after the 2nd day of the antibacterial treatment. RESULTS: Mean levels of serum hsCRP were 68.4 mg/dl, 68.3 mg/dl and 6.5 mg/dl in Groups 1, 2 and 3 respectively. Those levels were significantly higher in Groups 1 and 2 compared to Group 3 (p < 0.0001). After the 2nd day of ceftriaxone, serum hsCRP decreased to a mean level of 9.0 mg/dl in Group 1 and to 9.1 mg/dl in Group 2. CONCLUSION: These findings indicate that elevated hsCRP levels may discriminate patients with and without spontaneous bacterial peritonitis even in the presence of nonneutrocytic ascites, and may have utility in the assessment of treatment response.