The Diagnostic Value Of ALBI Score Combined With NLR And CRP In Patients With Liver Cirrhosis Complicated With Spontaneous Bacterial Peritonitis

Objective:Spontaneous Bacterial Peritonitis(SBP)is an intra-abdominal infection in patients with liver cirrhosis,which is one of the common complications and causes of death in patients with liver cirrhosis.Early diagnosis and antibiotic treatment can significantly improve the prognosis of patients.Patients with SBP lack characteristic clinical manifestations and signs in the early stage,and the clinical diagnosis mainly depends on the results of ascites examination.On the one hand,diagnostic puncture of ascites is an invasive operation,on the other hand,ascites neutrophil count can be inaccurate due to neutrophil lysis during transportation,and ascites culture is time-consuming,which has little guiding significance for early diagnosis and treatment.Therefore,the purpose of this study is to investigate the Albumin-bilirubin Score(ALBI),neutrophil-lymphocyte Ratio(NLR),and Neutrophil lymphocyte Ratio(NLR).The diagnostic value of non-ascites indicators such as NLR,C-reactive Protein(CRP)and their combined model for SBP in patients with cirrhosis ascites,which provides guidance and help for clinical timely diagnosis and treatment of SBP.Method:A total of 134 patients with cirrhosis ascites admitted to Qujing Hospital Affiliated to Kunming Medical University from January 2018 to September 2022 were selected as the research objects.According to whether they were combined with SBP,they were divided into SBP group and non-SBP group,and their data were collected.The general data such as gender,age,etiology of liver cirrhosis,course of disease,and laboratory examination data such as white blood cell,neutrophils,lymphocytes,albumin,total bilirubin,aspartate aminotransferase,alanine aminotransferase,activated partial thromboplastin time,and CRP were included.The ALBI score and NLR were calculated according to the calculation formula.Chi-square test,t test,rank sum test,Logistic regression analysis and other methods were used to screen out the factors affecting the occurrence of SBP.The joint model was established by the coefficient method,and the receiver operating characteristic(ROC)curve was drawn.The area under the curve,sensitivity and specificity,and Youden index were used to evaluate the diagnostic value of each single index and the combined model for SBP in liver cirrhosis.Results:1.General information: A total of 134 patients were included in this study,including 83 cases in SBP group and 51 cases in non-SBP group.There was no significant difference in age,gender and etiology between the two groups(P > 0.05).There were significant differences in the three clinical symptoms of abdominal distension,abdominal pain and fever between the two groups(P < 0.05).2.The results of ascites examination showed that there were 11 cases(13.25%)with positive ascites culture and 72 cases(86.75%)with negative ascites culture in SBP group,and the results of ascites culture in non-SBP group were all negative(100.00%),and the difference between the two groups was statistically significant(P< 0.05).3.Comparison of blood related laboratory test indicators between groups showed that:There were significant differences in albumin,total bilirubin,CRP,aspartate aminotransferase,alanine aminotransferase,creatinine,urea nitrogen,prothrombin time,activated partial thromboplastin time,international normalized ratio,white blood cell count,neutrophil count,ALBI score and NLR between SBP group and non-SBP group(P < 0.05).There was no significant difference in γ-glutamyl transpeptidase,alkaline phosphatase,total bile acid,uric acid,thrombin time,red blood cell,red blood protein and platelet(P > 0.05).4.Logistic regression analysis showed that ALBI score [OR=3.158,95%CI:1.091-9.140,P<0.05],NLR[OR=1.355,95%CI: 1.107-1.659,P<0.05] and CRP[OR=1.059,95%CI: 1.022-1.097,P<0.05] were the influencing factors of SBP in patients with liver cirrhosis.The combined ALBI-NLR-CRP model was established by coefficient method,and the formula was 1.150×ALBI score +0.3Logistic regression analysis showed that ALBI score [OR=3.158,95%CI: 1.091-9.140,P <0.05],NLR[OR=1.355,95%CI: 1.107-1.659,P < 0.05] and CRP[OR=1.059,95%CI:1.022-1.097,P < 0.05] were the influencing factors of SBP in patients with liver cirrhosis.The combined ALBI-NLR-CRP model was established by coefficient method,Logit(P)=1.150×ALBI score +0.304×NLR+0.057×CRP(mg/L)-0.857.The results of receiver operating curve analysis showed that the best cut-off value of ALBI score was-1,the area under the curve was 0.715,the Youden index was 0.369,the sensitivity and specificity were 66.30% and 70.60%,respectively.The optimal cut-off value of NLR was 4.58,the area under the curve was 0.808,the Youden index was0.533,the sensitivity and specificity were 65.10% and 88.20%,respectively.The optimal cut-off value of CRP was 12.95mg/L,the area under the curve was 0.790,the Youden index was 0.496,the sensitivity and specificity were 77.10% and 72.50%,respectively.The optimal cut-off value of ALBI-NLR-CRP combined model was 0.64,the area under the curve was 0.880,the Youden index was 0.712,the sensitivity and specificity were 77.10% and 94.10%,respectively.Conclusions: The AUC,Youden index,sensitivity and specificity of the combined model of ALBI-NLR-CRP were higher than those of ALBI score,NLR and CRP.The combined model included both liver function indicators and inflammatory indicators,and the single indicators of the model were all non-invasive indicators.It can reduce the risk of infection,bleeding,abdominal wall hematoma,difficult healing of puncture point,fluid leakage at puncture point,and intestinal perforation due to diagnostic abdominal puncture.It has potential value in the diagnosis of liver cirrhosis complicated with spontaneous peritonitis,and it is simple,easy and cheap,which is worthy of further verification and application in clinical practice.