Relation of Insulin like Growth Factor-1 to Bacterial Translocation in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is one of most common acute bacterial infections of ascitic fluid (AF) that occur in  cirrhotic patients.

Objective: This study aimed to compare serum levels of IGF-1 between patients with SBP and those with aseptic ascites and assess the  relationship between serum IGF-1 level and the occurrence of bacterial translocation indicated by presence of its marker LBP.

Patients and Methods: Serum insulin like growth factor 1(IGF-1) and lipopolysaccharide-binding protein (LBP) levels were measured in a  group of 49 patients with spontaneous peritonitis (SBP) and group of 39 patients with aseptic ascites.

Results: Total, symptomatic (36) and asymptomatic (13) SBP patients had significantly lower IGF1 and significantly higher LBP when  compared to aseptic ascites patients. Moreover, symptomatic SBP had significantly higher LBP when compared to asymptomatic SBP  patients. Serum LBP was significantly higher in symptomatic patients with positive AF culture results than those with negative culture  results [23.1 ng/mL (2.9-62.1) versus 15.1 ng/mL (2.5- 87.8) P: 0.037], AUC of LBP was 0.955 which carry good discrimination between SBP  patients and those with aseptic ascites. Blood and AF culture growth results and type of isolated organism did not differ significantly  among symptomatic and asymptomatic SBP patients. The most frequently isolated organism from blood and AF culture was E. coli  followed by coagulase negative staphylococci. 

Conclusions: SBP occurs more frequently in cirrhotic Child C patients who displayed lower  serum IGF-1 levels and higher serum LBP levels than cirrhotic patients with aseptic ascites, besides there was a significant negative correlation between serum IGF-1 and LBP levels indicating that decreased serum IGF-1 level in advanced liver disease contributes to  occurrence of microbial translocation.