Adjusted Intensive Care Infection Score (ICISΔ)—A new approach for prediction of ascitic fluid infection in patients with cirrhosis. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Wang, Han; Yang, Ning; Li, Yan; Zhang, Fangfang; Xie, Na; Li, Peiran; Sun, Zhiqiang; Zhu, Jiangong; Mao, Yuanli; Li, Boan
• Is Part Of: Digestive and liver disease. Volume 51:Issue 1(2019)
• Page Start: 104
• Page End: 111
• Publication Date: 2019-01
• Subjects: Ascitic fluid -- Infection -- ICIS -- PCT; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2018.06.006
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Early and accurate diagnosis is the key to improving survival in cirrhotic patients with ascitic fluid infection. Aims: To investigate the usefulness of adjusted Intensive Care Infection Score (ICISΔ ) for diagnosis of ascites infection in cirrhotic patients. Methods: Cirrhotic patients with ascites (n = 125) were enrolled, and the efficacy of ICIS and ICISΔ for predicting ascites infection was evaluated. ICISΔ was created by using the weighted variation of each ICIS parameter. Results: The area under the curves (AUCs) of ICIS for the diagnosis of ascites infection were 0.90 (95% CI: 0.84–0.95), 0.85 (95% CI: 0.79–0.90), and 0.87 (95% CI: 0.81–0.93), for SBP, culture-negative SBP, and combined SBP/culture-negative SBP, respectively. ICIS was optimized and diagnostic accuracy was obviously improved. ICISΔ had high AUCs of 0.99 (95% CI: 0.93–1.00) for SBP, 0.98 (95% CI: 0.83–1.00) for culture-negative SBP, and 0.98 (95% CI: 0.94–1.00) for the combination group. The optimal cutoff was identified as ICISΔ > 2, which had >97.8% sensitivity and 100% specificity for diagnosis of both SBP and culture-negative SBP. The ICISΔ had significantly higher AUCs than PCT and CPR in both groups ( P = 0.002–0.008). ICISΔ kinetics could differentiate between SBP and culture-negative SBP patients. From sterile ascites, through culture-negative SBP to SBP, three ICISΔ parameters showed an increasing trend. Conclusions: ICIS and ICISΔ are simple, rapid, accurate and cost-effective methods for the diagnosis of ascites infection in cirrhotic patients.