Diagnostic performance of different scores for predicting spontaneous bacterial peritonitis in cirrhotic patients

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotic patients with ascites. Numerous scores were proposed for SBP diagnosis with variable accuracies. Aim: To evaluate the diagnostic accuracy of procalcitonin (PCT), neutrophil/lymphocyte ratio (NLR), PCT, erythrocyte sedimentation rate, and C-reactive protein index (PEC index), and modified Wehmeyer and Mansoura scoring systems for SBP in cirrhotic patients with ascites. Methods: This cross-sectional hospital-based study included 81 adult cirrhotic patients with ascites admitted to the Tropical Medicine and Gastroenterology Department, Sohag University Hospital. Ten ml of fresh venous blood was obtained to assess serum PCT, complete blood count (CBC), transaminases, and prothrombin time (PT). NLR, PEC index, modified Wehmeyer, and Mansoura scoring systems were calculated and the Receiver Operator Curve (ROC) was used to evaluate their diagnostic accuracy for SBP. Results: SBP was diagnosed in 25 patients (30.68%). Fever, diarrhea, abdominal pain, and jaundice were significantly higher in SBP (p < 0.001, <0.001, 0.046, 0.018). The area under the ROC curve (AUC) of neutrophil/lymphocyte ratio (NLR), PEC index, Mansoura score, and Model of End Stage Liver Disease (MELD) score for SBP diagnosis was 0.7 at cutoff values of 3.6, 19.3, 3, and 17, respectively (p< 0.05). Conclusions: Regarding the scores that were compared, the NLR proved to have the highest sensitivity in identifying SBP, while the Mansoura score was the most specific. Risk factors like fever, diarrhea, abdominal pain, and high serum bilirubin were positively related to SBP.