Sirotik Hastalarda ve Spontan Bakteriyel Peritonitte Fekal Calprotectin Düzeylerinde Artış

Year 2019, , 214 - 217, 30.12.2019

Salih Tokmak , Ayşegül Harmancı Özakyol

https://doi.org/10.18678/dtfd.653549

Cited By: 4

Abstract

Amaç: Bu çalışmanın amacı, intestinal inflamasyonun göstergesi olan fekal calprotectin (FC) ile artmış intestinal inflamasyon ve buna bağlı artan bakteriyel translokasyon sonucu meydana gelen sirozun komplikasyonları arasındaki ilişkiyi araştırmaktır.

Gereç ve Yöntemler: Hastanemize başvuran 18 ve 80 yaş arası 156 sirotik hastadan, dışlama kriterlerine göre 64’ü çıkartıldı ve toplam 92 hasta ve benzer yaş ve cinsiyette 20 gönüllü kontrol grubu olarak çalışmaya dahil edildi. Başvuru sırasında alınan kan örneklerinden eritrosit sedimantasyon değeri (ESR), c-reaktif protein (CRP) ve beyaz küre sayımı (WBC) çalışıldı. Her hastadan ve kontrol grubundan başvurudan sonraki 24 saat içinde bir adet spot gaita örneği alındı. Çalışma grubu, sirozun evresi ilerledikçe veya komplikasyonlar meydana geldiğinde FC değerlerinin değişip değişmediğini incelemek için beş alt gruba (Child-Pugh Evre-A, Evre-B, Evre-C, hepatiks ensefalopati ve spontan bakteriyel peritonit) ayrıldı.

Bulgular: Ortanca FC değerleri sirotik hastalarda 168,8 mg/kg ve kontrol grubunda 9,8 mg/kg idi ve gruplar arasındaki farklılık istatistiksel olarak anlamlıydı (p=0,039). Alt grup incelemesinde, spontan bakteriyel peritonit grubu ile diğer tüm alt gruplar arasındaki farklılıklar istatistiksel olarak anlamlıydı (p=0,002). Sirotik hastalarda FC ile ESR (r=0.439, p=0.545) veya CRP (r=0.403, p=0.321) ya da WBC sayımı (r=0.061, p=0.645) arasında korelasyon saptanmadı.

Sonuç: Sirotik hastalarda FC değerleri yükselmektedir ve sistemik inflamasyon belirteçlerinden önce FC değerlerinin erken yükselmesi sayesinde, spontan bakteriyel peritonitte tanısal bir test olarak kullanılabilir.

Keywords

calprotectin, siroz, sekonder peritonit

Elevated Levels of Fecal Calprotectin in Cirrhotic Patients and Spontaneous Bacterial Peritonitis

Abstract

Aim: The aim of this study is to investigate the relationship between fecal calprotectin (FC) which is a marker for intestinal inflammation and complications of cirrhosis which are due to increased bacterial translocation and intestinal inflammation.

Material and Methods: Out of 156 cirrhotic patients aged between 18-80 years who are admitted to our hospital, 64 were excluded according to exclusion criteria and a total of 92 patients, and 20 volunteers with similar age and sex as a control group were included in this study. Serum samples were taken at admission to measure erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and white blood cell count (WBC). All patients and the control group provided a single stool sample within 24 hours after admission. The study group divided into five subgroups (Child-Pugh Grade A, Grade-B, Grade-C, spontaneous bacterial peritonitis and hepatic encephalopathy) to investigate whether FC levels change as the disease progress or complications occur.

Results: Median FC levels were 168.8 mg/kg for cirrhotic patients and 9.8 mg/kg for control group, and the difference between the groups was statistically significant (p=0.039). In the subgroup analysis, the differences between spontaneous bacterial peritonitis and all other subgroups were statistically significant (p=0.002). In cirrhotic patients, FC levels were not correlated either with ESR (r=0.439, p=0.545) or CRP (r=0.403, p=0.321) or WBC count (r=0.061, p=0.645).

Conclusion: FC levels are increased in cirrhotic patients and early increase in FC levels before the rise of systemic inflammation markers can be used as a diagnostic marker for spontaneous bacterial peritonitis.

Keywords

calprotectin, cirrhosis, secondary peritonitis

References

• Dale I., Fagerhol MK, Naesgaard I. Purification and partial characterization of a highly immunogenic human leukocyte protein, the L1 antigen. Eur J Biochem. 1983;134(1):1-6.
• Stríz I, Trebichavský I. Calprotectin - a pleiotropic molecule in acute and chronic inflammation. Physiol Res. 2004;53(3):245-53.
• Konikoff MR, Denson LA. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2006;12(6):524-34.
• Røseth AG, Schmidt PN, Fagerhol MK. Correlation between faecal excretion of indium-111-labelled granulocytes and calprotectin, a granulocyte marker protein, in patients with inflammatory bowel disease. Scand J Gastroenterol. 1999;34(1):50-4.
• Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014;60(1):197-209.
• van Rheenen, PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ. 2010;341:c3369.
• Homann C, Christensen E, Schlichting P, Philipsen EK, Graudal NA, Garred P. Ascites fluid and plasma calprotectin concentrations in liver disease. Scand J Gastroenterol. 2003;38(4):415-20.
• Homann C, Garred P, Graudal NA, Hasselqvist P, Christiansen M, Fagerhol MK, et al. Plasma calprotectin. A new prognostic marker of survival in alcoholic liver cirrhosis. Ugeskr Laeger. 1996;158(21):2980-4.
• Sipponen T, Kolho KL. Fecal calprotectin in diagnosis and clinical assessment of inflammatory bowel disease. Scand J Gastroenterol. 2015;50(1):74-80.
• Mumolo MG, Bertani L, Ceccarelli L, Laino G, Di Fluri G, Albano E, et al. From bench to bedside: Fecal calprotectin in inflammatory bowel diseases clinical setting. World J Gastroenterol. 2018;24(33):3681-94.
• Ayling RM, Kok K. Fecal calprotectin. In: Makowski GS, editor. Advances in clinical chemistry. Amsterdam, The Netherlands: Elsevier; 2018. p.161-90.
• Yagmur E, Schnyder B, Scholten D, Schirin-Sokhan R, Koch A, Winograd R, et al. Elevated concentrations of fecal calprotectin in patients with liver cirrhosis. Dtsch Med Wochenschr. 2006;131(36):1930-4.
• Gundling F, Schmidtler F, Hapfelmeier A, Schulte B, Schmidt T, Pehl C, et al. Fecal calprotectin is a useful screening parameter for hepatic encephalopathy and spontaneous bacterial peritonitis in cirrhosis. Liver Int. 2011;31(9):1406-15.
• Ibrahim AAE, Hussein MSA, Shady ZMZ, Metwally MMM, Amer ASM. Use of fecal calprotectin as a predictor of spontaneous bacterial peritonitis in post hepatitis C cirrhotic Egyptian patients. Egypt J Hosp Med. 2019;76(3):3736-40.
• Riggio O, Varriale M, Testore GP, Di Rosa R, Di Rosa E, Merli M, et al. Effect of lactitol and lactulose administration on the fecal flora in cirrhotic patients. J Clin Gastroenterol. 1990;12(4):433-6.
• Kamal F, Khan MA, Khan Z, Cholankeril G, Hammad TA, Lee WM, et al. Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2017;29(10):1109-17.
• Husebye E, Tøn H, Johne B. Biological variability of fecal calprotectin in patients referred for colonoscopy without colonic inflammation or neoplasm. Am J Gastroenterol. 2001;96(9):2683-7.