Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites

Ping JIANG; Rencheng DOU; Zijin CUI; Yinni TONG; Chen LI; Shanshan JIANG; Yun BAI; Jimin ZHENG; Cunkai WANG; Yuzhen WANG

doi:10.3969/j.issn.1001-5256.2021.09.019

Volume 37 Issue 9

Sep. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(9): 2097-2101

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Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites

DOI: 10.3969/j.issn.1001-5256.2021.09.019

1.
Graduate School of Hebei North University, Zhangjiakou, Hebei 075000, China
2.
Department of Gastroenterology, Hebei General Hospital, Shijiazhuang 050000, China

Research funding:

Medical Science Research Project of Hebei Province in 2019 (20190260)

Received Date: 2021-01-04
Accepted Date: 2021-01-27
Published Date: 2021-09-20

Abstract

Abstract

Objective To investigate the risk factors for spontaneous bacterial peritonitis (SBP) in patients with cirrhotic ascites, and to establish a new model for predicting the development of SBP. Methods A total of 215 patients who were diagnosed with cirrhotic ascites in Hebei General Hospital from September 2016 to September 2020 were enrolled, and according to the presence or absence of SBP, they were divided into SBP group with 55 patients and non-SBP group with 160 patients. Related clinical data were collected and albumin-bilirubin (ALBI) score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and Child-Pugh score were calculated. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to screen out independent risk factors, and the receiver operating characteristic (ROC) curve was plotted to evaluate the performance of ALBI score, procalcitonin (PCT), polymorphonuclear neutrophil (PMN) count in ascites, and the ALBI-PMN-PCT combined model in the diagnosis of SBP. Results Compared with the SBP group, the non-SBP group had a significantly higher concentration of Na⁺ (Z=-3.414, P=0.001) and significantly lower total bilirubin (Z=-2.720, P=0.007), creatinine (Z=-1.994, P=0.046), urea nitrogen (Z=-2.440, P=0.015), C-reactive protein (Z=-9.137, P < 0.001), PCT (Z=-8.096, P < 0.001), prothrombin time (Z=-1.969, P=0.049), international normalized ratio (Z=-2.073, P=0.038), PMN (Z=-8.292, P < 0.001), MELD score (Z=-2.736, P=0.006), MELD-Na score (Z=-3.188, P=0.001), Child-Pugh score (Z=-3.419, P=0.001), and ALBI score (t=-5.010, P < 0.001), and there were also significant differences between the two groups in the presence or absence of gastrointestinal bleeding or hepatic encephalopathy (χ²=16.551 and 8.142, P < 0.001 and P=0.004). The multivariate logistic regression analysis showed that ALBI score (odds ratio [OR]=3.460, 95% confidence interval [CI]: 1.296-9.240, P=0.013), PMN (OR=1.012, 95%CI: 1.007-1.017, P < 0.001), and PCT (OR=6.019, 95%CI: 2.821-12.843, P < 0.001) were independent risk factors for SBP in patients with cirrhotic ascites. The ROC curve showed that ALBI, PCT, PMN, and ALBI-PMN-PCT had areas under the ROC curve of 0.711, 0.866, 0.875, and 0.934, respectively, in the diagnosis of SBP, with sensitivities of 50.91%, 73.36%, 72.73%, and 89.09%, respectively, and specificities of 86.87%, 81.25%, 100.00%, and 91.87%, respectively. The patients with ALBI-PMN-PCT > 0.272 had an increased risk of developing SBP. Conclusion The ALBI-PMN-PCT combined model has a high value in predicting the onset of SBP in patients with cirrhotic ascites.
- Liver Cirrhosis,
- Peritonitis,
- Ascites,
- Calcitonin,
- Albumin-Bilirubin Score

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References

[1]	MARCIANO S, DÍAZ JM, DIRCHWOLF M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: Incidence, outcomes, and treatment strategies[J]. Hepat Med, 2019, 11: 13-22. DOI: 10.2147/HMER.S164250.
[2]	PIANO S, FASOLATO S, SALINAS F, et al. The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial[J]. Hepatology, 2016, 63(4): 1299-1309. DOI: 10.1002/hep.27941.
[3]	TANDON P, GARCIA-TSAO G. Bacterial infections, sepsis, and multiorgan failure in cirrhosis[J]. Semin Liver Dis, 2008, 28(1): 26-42. DOI: 10.1055/s-2008-1040319.
[4]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003. 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
[5]	JOHNSON PJ, BERHANE S, KAGEBAYASHI C, et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade[J]. J Clin Oncol, 2015, 33(6): 550-558. DOI: 10.1200/JCO.2014.57.9151.
[6]	DOMINGUEZ M, RINCÓN D, ABRALDES JG, et al. A new scoring system for prognostic stratification of patients with alcoholic hepatitis[J]. Am J Gastroenterol, 2008, 103(11): 2747-2756. DOI: 10.1111/j.1572-0241.2008.02104.x.
[7]	PUGH RN, MURRAY-LYON IM, DAWSON JL, et al. Transection of the oesophagus for bleeding oesophageal varices[J]. Br J Surg, 1973, 60(8): 646-649. DOI: 10.1002/bjs.1800600817.
[8]	KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
[9]	RUF AE, KREMERS WK, CHAVEZ LL, et al. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone[J]. Liver Transpl, 2005, 11(3): 336-343. DOI: 10.1002/lt.20329.
[10]	FASOLATO S, ANGELI P, DALLAGNESE L, et al. Renal failure and bacterial infections in patients with cirrhosis: Epidemiology and clinical features[J]. Hepatology, 2007, 45(1): 223-229. DOI: 10.1002/hep.21443.
[11]	PIANO S, BARTOLETTI M, TONON M, et al. Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections[J]. Gut, 2018, 67(10): 1892-1899. DOI: 10.1136/gutjnl-2017-314324.
[12]	SHIZUMA T. Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review[J]. World J Hepatol, 2018, 10(2): 254-266. DOI: 10.4254/wjh.v10.i2.254.
[13]	SCHWABL P, BUCSICS T, SOUCEK K, et al. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites[J]. Liver Int, 2015, 35(9): 2121-2128. DOI: 10.1111/liv.12795.
[14]	WANG Y, ZHANG Q. Analysis of risk factors for patients with liver cirrhosis complicated with spontaneous bacterial peritonitis[J]. Iran J Public Health, 2018, 47(12): 1883-1890.
[15]	WANG X, WANG BM, JIANG K, et al. The predictive value of end-stage liver disease model for spontaneous bacterial peritonitis in cirrhotic patients with ascites[J]. Chin J Intern Med, 2009, 48(8): 629-632. DOI: 10.3760/cma.j.issn.0578-1426.2009.08.005. 王鑫, 王邦茂, 姜葵, 等. 终末期肝病模型对肝硬化腹水患者并发自发性腹膜炎的预测价值[J]. 中华内科杂志, 2009, 48(8): 629-632. DOI: 10.3760/cma.j.issn.0578-1426.2009.08.005.
[16]	CHEN PC, CHEN BH, HUANG CH, et al. Integrated model for end-stage liver disease maybe superior to some other model for end-stage liver disease-based systems in addition to Child-Turcotte-Pugh and albumin-bilirubin scores in patients with hepatitis B virus-related liver cirrhosis and spontaneous bacterial peritonitis[J]. Eur J Gastroenterol Hepatol, 2019, 31(10): 1256-1263. DOI: 10.1097/MEG.0000000000001481.
[17]	GOYAL SK, DIXIT VK, JAIN AK, et al. Assessment of the model for end-stage liver disease (MELD) score in predicting prognosis of patients with alcoholic hepatitis[J]. J Clin Exp Hepatol, 2014, 4(1): 19-24. DOI: 10.1016/j.jceh.2014.02.006.
[18]	ABU RAHMA MZ, MAHRAN ZG, SHAFIK EA, et al. The role of serum procalcitonin level as an early marker of ascitic fluid infection in post hepatitic cirrhotic patients[J]. Antiinflamm Antiallergy Agents Med Chem, 2021, 20(1): 61-67. DOI: 10.2174/1871523019666200303104932.
[19]	HU DC, DU L, CAO CH, et al. Serum procalcitonin and C-reactive protein levels in predicting spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis[J]. J Prac Hepatol, 2020, 23(5): 699-702. DOI: 10.3969/j.issn.1672-5069.2020.05.024. 扈登财, 杜莉, 曹成红, 等. 血清降钙素原和C-反应蛋白水平预测肝硬化患者发生自发性细菌性腹膜炎的价值分析[J]. 实用肝脏病杂志, 2020, 23(5): 699-702. DOI: 10.3969/j.issn.1672-5069.2020.05.024.
[20]	CHEN SS, YAN HX, DU JP, et al. Association between Albumin-Bilirubin (ALBI) score and the relapse of autoimmune hepatitis[J]. J Med Res, 2019, 48(3): 70-76. DOI: 10.11969/j.issn.1673-548X.2019.03.017. 陈帅帅, 颜海希, 杜菊萍, 等. 白蛋白-胆红素(ALBI)评分与自身免疫性肝炎复发的相关性[J]. 医学研究杂志, 2019, 48(3): 70-76. DOI: 10.11969/j.issn.1673-548X.2019.03.017.
[21]	CHEN RC, CAI YJ, WU JM, et al. Usefulness of albumin-bilirubin grade for evaluation of long-term prognosis for hepatitis B-related cirrhosis[J]. J Viral Hepat, 2017, 24(3): 238-245. DOI: 10.1111/jvh.12638.
[22]	CHAN AW, CHAN RC, WONG GL, et al. New simple prognostic score for primary biliary cirrhosis: Albumin-bilirubin score[J]. J Gastroenterol Hepatol, 2015, 30(9): 1391-1396. DOI: 10.1111/jgh.12938.

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Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites

DOI: 10.3969/j.issn.1001-5256.2021.09.019

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