Ascitic Fluid Markers Hepcidin, Calprotectin, and Lactoferrin in Early Diagnosis and Follow-up of Spontaneous Bacterial Peritonitis

Abstract
Background: Spontaneous Bacterial Peritonitis (SBP) is the most serious complication in patients with decompensated liver cirrhosis and ascites. Its diagnosis is based on Polymorph Nuclear Leucocyte (PMNL) count in ascitic fluid >250 cell/mm3, however; SBP occurs at even lower levels, hence the need for early sensitive and specific markers for early detection and prognosis of SBP.
Aim of Study: The aim of the study was to assess ascitic fluid Calprotectin, Lactoferrin and Hepcidin as reliable markers for diagnosis and follow-up of SBP.
Patients and Methods: Ascitic fluid samples were collected from 88 patients with ascites; 37 with SBP (patients group) and 51 without SBP (control group). Calprotectin, Lactoferrin and Hepcidin levels were measured using Enzyme Linked Immunosorbent assay (ELISA).
Results: Calprotectin, Lactoferrin and Hepcidin were significantly higher in patients with SBP than those without SBP (p=0.002, 0.001, 0.029 respectively). The areas under the receiver operator characteristic curve for Calprotectin, Lactoferrin and Hepcidin were (0.695, 0.860 & 0.661 respec-tively) with sensitivity 91.9% for the three markers. Hepcidin showed higher specificity (64.7%) than the other two markers. Calprotectin and Hepcidin decreased significantly after proper antibiotic therapy than before therapy in SBP group (p=0.002 & 0.004 respectively).
Conclusion: Ascitic fluid Calprotectin, Lactoferrin and Hepcidin can be used as diagnostic markers of SBP. Calpro-tectin and Hepcidin can be used as markers for follow-up of SBP. Hepcidin was the most specific among them.