48 ��g/mL (1.61-3.65) vs 0.10 ��g/mL (0.10-0.36), P < 0.001] and POC [2.78 ��g/mL (2.05-5.37) Vismodegib FDA vs 0.38 ��g/mL (0.38-0.41), P < 0.001]. The area under the receiver operating characteristics curve for identifying an elevated PMN count was 0.977 (95%CI: 0.933 to 0.995) for ELISA and 0.982 (95%CI: 0.942 to 0.997) for POC (P = 0.246 vs ELISA). Using the optimal cut-off value for ELISA (0.63 ��g/mL), ascitic calprotectin had 94.8% sensitivity, 89.2% specificity, positive and negative likelihood ratios of 8.76 and 0.06 respectively, positive and negative predictive values of 60.0% and 99.0% respectively, and 90.0% overall accuracy. Using the optimal cut-off value for POC (0.51 ��g/mL), the respective values were 100.0%, 84.7%, 6.53, 0.00, 52.8%, 100% and 87.7%. Correlation between ELISA and POC was excellent (r = 0.

873, P < 0.001). The mean �� SD of the difference was -0.11 �� 0.48 ��g/mL with limits of agreement of + 0.8 ��g/mL (95%CI: 0.69 to 0.98) and -1.1 ��g/mL (95%CI: -1.19 to -0.91). CONCLUSION: Ascitic calprotectin reliably predicts PMN count > 250/��L, which may prove useful in the diagnosis of SBP, especially with a readily available bedside testing device. Keywords: Calprotectin, Ascites, Liver cirrhosis, Spontaneous bacterial peritonitis, Polymorphonuclear cells INTRODUCTION Liver cirrhosis is the clinical end-stage of different entities of chronic liver disease when patients suffer from substantial mortality and morbidity, both of which are positively correlated with disease severity[1,2].

Ascites is the most common complication, and around 60% of patients with compensated cirrhosis develop ascites within 10 years of disease onset[3]. Spontaneous bacterial peritonitis (SBP) is an important cause of morbidity and mortality in cirrhotic patients with ascites. SBP is estimated to affect 10%-30% of cirrhotic patients hospitalised with ascites, and mortality in this group approaches 30%[4,5]. Many of these patients are asymptomatic, and it is therefore recommended that all patients with ascites undergo paracentesis at the time of admission to confirm the SBP status[5]. Although SBP is less prevalent in an outpatient setting, it is reasonable to also evaluate the ascitic fluid of outpatients because of the high mortality associated with SBP. The diagnosis of SBP is based upon the polymorphonuclear (PMN) leukocyte cell count exceeding 250/��L in ascitic fluid[6,7].

Currently, differential cell count is usually performed by a manual method using light microscopy and counting chambers. However, Cilengitide the diagnosis is often delayed when laboratory personnel are not readily available or in the private practice setting where specimens are sent to an offsite laboratory. This is a major drawback, as rapid diagnosis of SBP and immediate initiation of antibiotic treatment is of paramount importance.