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.