Alterations in cytokine measurements in ascitic fluid of cirrhotic patients with and without spontaneous bacterial peritonitis

Aim: To determine the pattern of cytokine synthesis in the ascitic fluid (AF) of cirrhotic patients, with or without spontaneous bacterial peritonitis (SBP). Patients and methods: We prospectively studied 13 cirrhotic patients with ascites, who were admitted at the University Hospital of Patras from May 2008 to December 2009. Patients were separated into two groups: (a) group 1: patients SBP (n=7) (b) group 2: patients without SBP (n=6). Cirrhosis was diagnosed on the basis of typical clinical, laboratory, ultrasonographic findings and/ or liver biopsy. Upon admission a paracentesis of ascetic fluid was performed. Ascitic levels of IL1b, IL-1ra, IL-6, IL10, TNFa, sTNFRI and sTNFRII were measured by using an ELISA method. Data are presented as absolute numbers (mean±standard deviation) and were compared using t test. A P value <0.05 was considered significant. Results: Most patients, who were prospectively included in this study and were admitted to the hospital, were males and had cirrhosis due to alcohol abuse. The second cause of cirrhosis in this population was virus hepatitis (B, C or both). The middle age was 69±12 years and 62±15 years for Group 1 and Group 2 respectively. Multivariate analysis of proinflammator and antiinflammatory cytokines showed significant (P<0.05) differences in the levels of sTNFRII and IL-1ra between the two groups of patients (group 1: cirrhotics with SBP vs group 2: cirrhotics without SBP). Ascitic levels of IL-10, IL-6, IL-1ra, TNF-a, STNFRII and STNFRI were higher in ascitic fluid of patients with bacterial ascites, while TGF-b1 levels were lower in the ascitic fluid of patients with SBP (differences not significant). It is remarkable that IL-1b was not expressed in patients either with or without spontaneous bacterial peritonitis SBP. Conclusions: We demonstrated an increased cytokine production in ascitic fluid of cirrhotic patients with SBP, while the levels of anti-inflammatory cytokines sTNFRII and IL-1ra are significantly increased in SBP. It seems, therefore, that an ascitic fluid antiinflammatory response is characteristic in SBP, and this might compromise the final outcome.