Brief Article
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World J Gastroenterol. Mar 7, 2014; 20(9): 2374-2382
Published online Mar 7, 2014. doi: 10.3748/wjg.v20.i9.2374
Procalcitonin, and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites
Bashar M Attar, Christopher M Moore, Magdalena George, Nicolae Ion-Nedelcu, Rafael Turbay, Annamma Zachariah, Guiliano Ramadori, Jawed Fareed, David H Van Thiel
Bashar M Attar, Rafael Turbay, Annamma Zachariah, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States
Bashar M Attar, Christopher M Moore, Magdalena George, David H Van Thiel, Division of Gastroenterology and Hepatology, Rush University Medical Center, Chicago, IL 60612, United States
Nicolae Ion-Nedelcu, Division of Gastroenterology and Hepatology, Victor Babes Infectious Clinic, 050094 Bucharest, Romania
Guiliano Ramadori, Division of Gastroenterology and Hepatology, August Georg University, D-37075 Gottingen, Germany
Jawed Fareed, Division of Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL 60153, United States
Author contributions: Attar BM contributed to study design, literature search, patient identification, data collection, data analysis, and manuscript writing; Moore CM contributed to data collection and manuscript writing; George M contributed to study design, laboratory work, data collection, data analysis, and manuscript writing; Ion-Nedelcu N contributed to study design and data analysis; Turbay R contributed to identification of patients with ascites and data collection; Zachariah A contributed to identification of patients with ascites and data collection; Ramadori G contributed to study design and data analysis; Fareed J contributed to study design and data analysis; Van Thiel DH contributed to study hypothesis, study design, data collection, data analysis, and manuscript writing.
Correspondence to: Bashar M Attar, MD, PhD, AGAF, FACP, FACG, FASGE, Professor of Medicine, Division of Gastroenterology and Hepatology, John H Stroger Hospital of Cook County, 1901 W. Harrison Street, Admin. bldg, Suite 1450, Chicago, IL 60612, United States. battar@rush.edu
Telephone: +1-312-8647213 Fax: +1-312-8649214
Received: February 26, 2013
Revised: April 23, 2013
Accepted: June 1, 2013
Published online: March 7, 2014
Core Tip

Core tip: Procalcitonin received much attention as a serum marker in differentiating sepsis from systemic inflammatory response syndrome and bacterial sepsis. Procalcitonin significance in assessing ascitic fluid inflammation and/or infection is less well characterized. This study demonstrates that non-infected cirrhotics with ascites vs those without ascites manifest peri-peritoneal based immune response mediated by a constellation of pro- and anti-inflammatory protein markers and procalcitonin. This peri-peritoneal response is distinct from the systemic immune response to the underlying hepatic disease process. Its recognition can potentially determine the likelihood for future adverse events like spontaneous bacterial peritonitis, the hepato-renal syndrome and impending death.