Details
Category: Volume 08 Issue 02 February 2020
Hits: 1543

Title: Significance of Ascitic Fluid C-Reactive Protein in Differentiating Malignancy Related Ascites from Benign Ascites

Authors: Jinsha K. A, Arun P, Gireesh G. N

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.140

Abstract

   

Introduction: Simple test(s) on ascitic fluid or serum which can help differentiate between Malignancy and Non-Malignancy Related ascites is a challenge that is not always met satisfactorily.

Aim: The purpose of this study is to assess the usefulness of Ascitic Fluid C-Reactive Protein (CRP) in differential diagnosis of Ascites.

Methodology: This prospective study included 80 patients with Ascites, admitted to Medical Gastroenterology Department of Madras Medical College, from January 2018 to January 2019. The patients were divided into two groups – Malignant ascites (n=30) and Non-malignant Ascites (n=50). The modalities for selecting malignant group were either cytology/ peritoneal biopsy positive cases. Complete Blood Count, LFT, Ascitic Fluid Analysis including Total Protein, albumin, cholesterol, CRP, culture & sensitivity, Total and differential counts were done in all patients. USG abdomen, upper GI endoscopy, CECT abdomen, ADA, FNAC of peritoneal nodules and liver biopsy were performed in selected cases. Bacterial peritonitis was excluded in all these patients.Serum and ascitic fluid CRP were analyzed in all cases. Data were entered in Microsoft Excel and analyzed using IBM SPSSS (Ver. 20.0)

Results: Mean value of Ascitic Fluid CRP were significantly higher in Malignancy group than Non-malignancy group (16.6±13.4 vs 2.1±3.2 ng/ml) (p value 0.001). Serum CRP was also significantly higher in malignant ascites than benign ascites patients [10.8±6.3 mg/ml vs. 6.2±4.9 mg/ml;p<0.001].

Conclusion: Elevated ascitic fluid and serum CRP values can be used to differentiate malignancy related ascites from benign ascites.

Keywords: Ascites; Ascitic Fluid; CRP; C-reactive protein; Malignant.

References

  1. Abdel-Razik A, Mousa N, Elalfy H, et al. A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites. Journal of Gastrointestinal Cancer. 2017 Mar;48(1):50-57. DOI: 10.1007/s12029-016-9873-x.
  2. Yuksel, I., Karaahmet, F., Coskun, Y. et al. Significance of Serum and Ascitic Fluid C-Reactive Protein in Differential Diagnosis of Benign and Malignant Ascites. Dig Dis Sci 59, 2588–2593 (2014). https://doi.org/10.1007/s10620-014-3205-4
  3. Rana SV, Babu SG, Kocchar R. Usefulness of ascitic fluid cholesterol as a marker for malignant ascites. Med Sci Monit 2005;11(3):CR136-42.
  4. Wang CS, Sun CF. C-reactive protein and malignancy: clinico-pathological association and therapeutic implication. Chang Gung medical journal. 2009;32:471-82
  5. Bijoor AR, Venkatesh T. Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites. Indian Journal of Clinical Biochemistry 2001;16(1):106-9.
  6. Sangisetty SL, Miner TJ. Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg 2012; 4(4): 87-95
  7. Schofield J, Krausz T. Metastatic disease and lymphomas. In: Diagnostic Cytopathology, 2nd ed, Gray W, McKee GT, ed. Elsevier, 2003:153–204
  8. Sproston NR and Ashworth JJ (2018) Role of C-Reactive Protein at Sites of Inflammation and Infection. Front. Immunol. 9:754. doi: 10.3389/fimmu.2018.00754
  9. Jain S, Gautam V, Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioall Sci 2011;3:118-27
  10. Volarić D, Flego V, Žauhar G, Bulat-Kardum L. Diagnostic value of tumour markers in pleural effusions. Biochem Med (Zagreb). 2018;28:010706
  11. Ramona C. Dolscheid-Pommerich, Steffen Manekeller, Gisela Walgenbach-Brünagel, Jörg C. Kalff, Gunther Hartmann, Birgit Stoffel Wagner, And Stefan Holdenrieder. Clinical Performance of CEA, CA19-9, CA15-3, CA125 and AFP in Gastrointestinal Cancer Using LOCI™-based Assays Anticancer Res January 2017 37 (1) 353-359
  12. Westhuyzen, Justin & Healy, Helen. (2000). Review: Biology and relevance of C-reactive protein in cardiovascular and renal disease. Annals of clinical and laboratory science. 30. 133-43.
  13. Sproston NR and Ashworth JJ (2018) Role of C-Reactive Protein at Sites of Inflammation and Infection. Front. Immunol. 9:754. doi: 10.3389/fimmu.2018.00754

Corresponding Author

Jinsha K. A

Institute of Medical Gastroenterology, Madras Medical College, The Tamil Nadu Dr. M.G.R Medical University, Chennai, India