الفهرس 
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Abstract
Ascitis is the most common complication of cirrhosis in patients with liver disease. Ascitic fluid can become infected without any apparent intra-abdominal source of infection, a condition called SBP. SBP secondary to chronic Hepatitis C virus (HCV) infection is a major health problem in Egypt with high mortality rate 20-40%.
Diagnosis of SBP depends on the PMNL count in ascitic fluid which is operator dependant and lysis of PMNL may occur during transport of ascitic fluid sample to the laboratory.
The main objectives of this study were to asses the diagnostic value of lactoferrin in cases of SBP.
Ninety sex patients proved to be HCV positive by HCV Ab and developed end stage liver disease by clinical examination and laboratory investigations (including:- S. albumin, prothrombin concentration, S. billirubin, and liver enzymes). Accordingly, the patients were divided into two groups according to the presence or absence of SBP.
Culture of ascitic fluid was done and the culture sensitivity was 35% only although all cases included were diagnosed as SBP.
The most isolated organism was E.coli and the least organisms were Pseudomonas aeruginosa and MRSA.
The antibiogram of this study showed complete change in the sensitivity of isolated organisms, in which all isplates of Gram negative bacteria were sensitive to imipenam and resistant to all other antibiotics, and the only Gram positive isolate was sensitive to vancomycin and ciprofloxacin.
Diagnostic parametars of ascitic fluid were done for all patients including: LDH, PMNL, glucose level, and albumin ratio. PMNL was the only test that could be used for diagnosis as it was postivley correlated with clinical manifestations of SBP.
Lactoferrin ascitic fluid concentration was estimated by ELIZA and the result was promising as it was sigificantly elevated in 60 SBP postive patients and positively correlated with PMNL count.
In this study it was found that lactoferrin was elevated in all cases diagnosed clinically as having SBP, although the result of the culture was negative.
At cut off value of 88 ng/ml lactoferrin showed a very high sensitivity and specificity. It had a sensitivity of 100% and specificity of 91.7%.
- Ascitic fluid lactoferrin level is a promising diagnostic parametar that could be used in diagnosis SBP espicially in those with culture negative result.
- Ascitic fluid lactoferrin level is positively correlated with PMNL count which makes this test of very important value because it is not operator dependent and it is not destroyed at room temprature.
- The findings of this study, suggest that ascitic fluid lactoferrin can serve as a sensitive and specific initial screening test for detection of SBP in cirrhotic patients with ascitis.
- At cut off value of 88 ng/ml lactoferrin showed a very high sensitivity and specificity. (It was showen a sensitivity of 100% and specificity of 91.7%).