February 2020 Vol. 8 No.2

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Original Research Article

Evaluation of C Reactive Protein Levels in Spontaneous Bacterial Peritonitis in Patients with Decompensated Chronic Liver Disease

¹Dr Rizwan Saeed Kiyani, ²Dr Muhammad Abdul Quddus, ³*Dr Sadia Rehman, ⁴Dr Muhammad Nadeem,
⁵Dr Kapeel Raja and ⁶Dr Santosh Kumar and ⁷Dr Sheikh Taqqi Anwar

¹Senior Registrar Gastroenterology, Poonch Medical College Azad Kashmir
²Assistant Professor Gastroenterology, Poonch Medical College Azad Kashmir
³Lecturer, Department of biochemistry, Bahria University Medical and Dental College, Karachi, Pakistan.
⁴Associate Professor of Medicine, Poonch Medical College Rawalakot Azad Kashmir
⁵Assistant Professor, Department of Gastroenterology Hepatology and Nutrition, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences Gambat
⁶Assistant Professor, Department of Nephrology, Jinnah Sindh Medical University Karachi Pakistan
⁷Senior Registrars Gastroenterology, Poonch Medical College Rawalakot

*Corresponding Author’s E-mail: dr.sadia89@hotmail.com

Accepted February 23, 2020

Abstract

The objective of the study was to determine the diagnostic accuracy of CRP for evaluation of spontaneous bacterial peritonitis in patients with decompensated chronic liver disease keeping ascitic fluid neutrophilic count more than 250/mm3 as a gold standard. This cross section validation study was conducted from 01-02-2014 to 20-12-2014 at Department of Medicine Shifa International Hospital, Islamabad, Pakistan. One hundred and eighty six cases were included in this study after fulfilling the inclusion criteria. Patients’ medical record number (MR), age and gender were recorded upon admission. Baseline investigations including complete blood count, urine RE and chest X-ray were done. An abdominal ultrasound was done to confirm the presence of ascites. Diagnostic abdominal paracentesis was done with 24 gauge needle. A diagnosis of spontaneous bacterial peritonitis was made and documented if>250 mm3 neutrophils are found in scetic fluid. A serum sample was drawn for CRP and the results were reported in mg/L. The minimum neutrophil count in scetic fluid was found as 45/mm3 and maximum neutrophil count in scetic fluid was 2550/mm3 with mean + standard deviation 794.60 + 1032.53/mm3. The minimum CRP level was found as 5 mg/L and maximum CRP level was 160 mg/L with mean + standard deviation 52.42 + 60.66 mg/L. Spontaneous bacterial peritonitis was present in 32.8% patients of decompensated chronic liver disease and 67.2% patients were without spontaneous bacterial peritonitis. There were 36% patients in which CRP levels was greater than 29.5mg/L and there were 64% patients in which CRP levels was less than 29.5mg/L. The sensitivity was calculated as 83.61%, specificity was calculated as 87.2%, positive predictive value was 76.12%, negative predictive value was 91.59% and diagnostic accuracy was observed from the collected data as 86.02%.A CRP level of ≥29.5mg/L gave 86.02% accuracy for the diagnosis of spontaneous bacterial peritonitis in patients presenting with decompensated chronic liver disease. So CRP is reliable for bacterial infection in subjects admitted due to complications of chronic liver disease.

Keywords: Chronic Liver Disease, CRP Level, Spontaneous Bacterial Peritonitis