Association of increased Fecal Calprotectin levels with hepatic encephalopathy and spontaneous peritonitis in Egyptian cirrhotic patients

Abstract

Aim: to investigate fecal calprotectin concentrations in Egyptian HCV related cirrhotic patients and recognize the relationship between these concentrations and liver cirrhosis complications as hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP).

Materials and Methods: This was a case-control observational study, fecal calprotectin levels were checked in 100 subjects by ELISA kits; 25 cirrhotic patients experienced HE, 25 cirrhotic patients experienced SBP, 25 cirrhotic patients without previous HE or SBP episodes in addition to 25 healthy subjects served as a control group. ROC curve analysis was used to detect the cutoff value which predicts these complications.

Results: Fecal calprotectin levels were significantly elevated in cirrhotic patients and correlated with the severity of liver disease (r=0.64, P=0.0001). Median fecal calprotectin concentrations were significantly (P=0.001) higher in HE and SBP groups than noncomplicated cirrhotic group (382.3, 358.8, 239.7mg/kg respectively). Despite that Fecal concentrations were decreased following recovery from HE, these concentrations remained significantly higher in comparison to patients without previous HE episode (292.3 versus 239.7mg/kg, P=0.04), in addition, levels were more significant in patients with ascites (P=0.003). ROC curve revealed that fecal calprotectin concentrations over 292.7 and 292.2mg/kg could predict patients with HE and SBP respectively, with high sensitivity and specificity.

Conclusion: Fecal Calprotectin has clinical value in patients with encephalopathy and SBP. Levels over 292 mg/kg may be used as a biological risk marker for SBP and HE development in Egyptian HCV related cirrhotic patients; however, further large-scale studies are needed.

Keywords: hepatic encephalopathy, ascites, cirrhosis, peritonitis, calprotectin.