The value of ascitic neutrophil gelatinase-associated lipocalin in decompensated liver cirrhosis with spontaneous bacterial peritonitis.

Background: Spontaneous bacterial peritonitis (SBP) is one of the most critical complications of decompensated liver cirrhosis. This study aimed to assess whether ascitic neutrophil gelatinase-associated lipocalin (NGAL), a reliable inflammation biomarker, can be used to detect SBP in decompensated cirrhosis patients and to predict mortality from decompensated cirrhosis-related SBP.

Methods: This study included 204 hospitalized patients with ascites of decompensated liver cirrhosis and follow-up of 28 days. We measured ascitic NGAL levels by the latex-enhanced immunoturbidimetric method. Simultaneously, we observed the patterns of ascitic NGAL levels in the SBP group after 7 days of anti-infection treatment with third-generation cephalosporins.

Results: The ascitic NGAL levels significantly increased in the SBP group compared with that in the non-SBP group, 111(83.9, 178) ng/mL vs 48(35.4, 63) ng/mL, P < .001. Likewise, the ascitic NGAL levels of SBP were higher than non-SBP with or without renal dysfunction. There was a positive relationship between ascitic NGAL and ascitic polymorphonuclear (PMN) leukocyte and a negative relationship between ascitic NGAL and ascitic albumin in the SBP group. An ascitic NGAL cutoff of 108.95 ng/mL was used for predicting a poor prognosis for SBP patients. Ascitic NGAL and the model for end-stage liver disease score were independent risk factors in decompensated liver cirrhosis patients with SBP through multivariate Cox regression. A dynamic trend of ascitic NGAL in SBP patients was consistent with the clinical prognosis.

Conclusion: Ascitic NGAL may not only be a biomarker for monitoring SBP but also a predictor for more severe outcomes in decompensated cirrhosis-related SBP.