Calprotectin as Diagnostic Marker for Hepatic Encephalopathy and Spontaneous Bacterial Peritonitis in Cirrhosis

Ascites fluid calprotectin level is highly accurate in diagnosing spontaneous bacterial peritonitis: a preliminary proof of concept prospective study

Ascites is the most common complication of liver cirrhosis. Spontaneous bacterial peritonitis (SBP) is a common complication of ascites. The diagnosis is made by an ascitic fluid polymorphonuclear (PMN) cell count of ≥ 250/mm3. However, no other diagnostic test is present for the diagnosis of SBP. The aim of the study present study is to assess the diagnostic yield of ascitic calprotectin in SBP, and to explore whether it can predict disease stage. We performed a single center proof-of-concept prospective study including all patients with cirrhosis and ascites who underwent paracentesis. Overall, 31 patients were included in the study. Eight patients had SBP vs. 23 patients without SBP. Ascitic calprotectin level was 77.4 ± 86.5 μg/mL in the SBP group, as compared to 16.1 ± 5.6 μg/mL in the non-SBP group (P = 0.001). An ascitic calprotectin cut-off value of > 21 μg/mL was associated with sensitivity and specificity of 85.7% and 89.5%, respectively, with ROC of 0.947 (95% CI 0.783 to 0.997, P < 0.0001). Notably, ascitic calprotectin did not had a prognostic value in cirrhosis stage and prognosis. Ascitic calprotectin was highly accurate in the diagnosis of SBP. It can be a serve as adjunct for indefinite cases of SBP.

Evaluation of DiaSorin Liaison® calprotectin fecal assay adapted for pleural effusion

Objectives

Calprotectin (CP) is a calcium and zinc binding protein that is widely measured on faecal samples but its determination in other biological fluids might be of interest. The aim of this work was to validate the measurement of CP in pleural fluid by chemiluminescence.

Methods

LIAISON®XL, a fully automated chemiluminescence analyzer, was used for CP quantification on pleural fluid. A validation protocol was designed using both quality control materials provided by the manufacturer and pools of pleural fluid samples. Stability, imprecision, bias, linearity, detection capability and carry over effect were evaluated.

Results

CP was stable on pleural fluid at least one week, under refrigerated conditions, and four weeks at -80 °C. The observed intra- and inter-day imprecision was between 2.2 and 6.49 %, with a negative bias under 5.51 %. The linearity of the method was verified up to 2,000 ng/mL. The LoQ for the assay was 48.52 ng/mL. A statistically significant carry-over effect was observed after measuring CP concentrations above the upper limit of linearity, but given the observed magnitude, a clinically relevant impact should not be expected.

Conclusions

DiaSorin Liaison® calprotectin assay allows reliable measurement of CP in pleural fluid.

Evaluación de la prueba fecal Liaison® Calprotectin de DiaSorin adaptada al derrame pleural

Objetivos

La calprotectina (CP) es una proteína de unión a calcio y zinc que se suele determinar en muestras fecales, aunque su cuantificación en otros fluidos biológicos podría ser de interés. El objetivo del presente estudio es validar la determinación de CP en líquido pleural mediante quimioluminiscencia.

Métodos

Para la cuantificación de CP en líquido pleural, se utilizó LIAISON®XL, un autoanalizador de quimioluminiscencia. Se diseñó un protocolo de validación empleando tanto materiales de control de calidad suministrados por el fabricante, como soluciones de muestras de líquido pleural. Se evaluaron la estabilidad, imprecisión, sesgo, linealidad, capacidad de detección y efecto de arrastre.

Resultados

La CP permaneció estable en líquido pleural refrigerado durante al menos una semana, y durante cuatro semanas a −80 °C. La imprecisión intradía e interdía observada fue del 2,2 % y del 6,49 %, respectivamente, con un sesgo negativo del 5,51 %. La linealidad del método se verificó hasta los 2000 ng/mL. El límite de cuantificación (LoQ) de la prueba fue de 48,52 ng/mL. Se observó un efecto de arrastre estadísticamente significativo tras medir concentraciones de CP superiores al límite máximo de linealidad. Sin embargo, dada la magnitud observada, no se debe esperar un impacto clínicamente relevante.

Conclusiones

La prueba Liaison® Calprotectin de DiaSorin es fiable para la determinación de CP en líquido pleural.

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

Background

The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis.

Materials and methods

In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA.

Results

Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease.

Conclusion

Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN.