Acute phase proteins in the diagnosis and prediction of cirrhosis associated bacterial infections.

Abstract

BACKGROUND:

Bacterial infections are common cause of morbidity and mortality in patients with cirrhosis. The early diagnosis of these infections is rather difficult.

AIMS:

To assess the accuracy of acute phase proteins in the identification of bacterial infections.

METHODS:

Concentration of C-reactive protein (CRP), procalcitonin (PCT), lipopolysaccharide-binding protein (LBP), sCD14 and antimicrobial antibodies were measured in serum of 368 well-characterized patients with cirrhosis of whom 139 had documented infection. Clinical data was gathered by reviewing the patients' medical charts.

RESULTS:

Serum levels of CRP, PCT and LBP were significantly higher in patients with clinically overt infections. Among the markers, CRP - using a 10 mg/L cut-off value- proved to be the most accurate in identifying patients with infection (AUC: 0.93). The accuracy of CRP, however, decreased in advanced stage of the disease, most probably because of the significantly elevated CRP levels in non-infected patients. Combination of CRP and PCT increased the sensitivity and negative predictive value, compared with CRP on its own, by 10 and 5% respectively. During a 3-month follow-up period in patients without overt infections, Kaplan-Meier and proportional Cox-regression analyses showed that a CRP value of >10 mg/L (P = 0.035) was independently associated with a shorter duration to progress to clinically significant bacterial infections. There was no correlation between acute phase protein levels and antimicrobial seroreactivity.

CONCLUSIONS:

C-reactive protein on its own is a sensitive screening test for the presence of bacterial infections in cirrhosis and is also a useful marker to predict the likelihood of clinically significant bacterial infections in patients without overt infections.

• Authors: Maria Papp, Zsuzsanna Vitalis, Istvan Altorjay, Istvan Tornai, Miklos Udvardy, Jolan Harsfalvi, Andras Vida, Janos Kappelmayer, Peter L Lakatos, Peter Antal-Szalmas
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 32 Issue 4 Pg. 603-11 (Apr 2012) ISSN: 1478-3231 [Electronic] United States
• PMID: 22145664 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 John Wiley & Sons A/S.

Chemical References

• Acute-Phase Proteins
• CALCA protein, human
• Carrier Proteins
• Membrane Glycoproteins
• Protein Precursors
• lipopolysaccharide-binding protein
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• Acute-Phase Proteins (analysis)
• Adult
• Aged
• Bacterial Infections (complications, diagnosis, microbiology)
• C-Reactive Protein (analysis)
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Carrier Proteins (blood)
• Female
• Humans
• Kaplan-Meier Estimate
• Likelihood Functions
• Liver Cirrhosis (complications)
• Male
• Membrane Glycoproteins (blood)
• Middle Aged
• Proportional Hazards Models
• Protein Precursors (blood)
• ROC Curve
• Regression Analysis