Role of Serum Homocysteine in Spontaneous Bacterial Peritonitis

Document Type : Original Article

Authors

1 Department of Hepatology, Gastroenterology and Infectious Diseases, Ahmed Maher Teaching Hospital, Ministry of Health, Cairo, Egypt

2 Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

3 Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

Background: Spontaneous bacterial peritonitis [SBP] is a severe and potentially life-threatening infection that commonly occurs in patients with liver cirrhosis and ascites. The pathogenesis of SBP is not fully understood, but several risk factors have been identified. Recent studies suggest that serum homocysteine levels may play a role in the development and progression of SBP.
Aim of the work: The aim of this study was to investigate the association between serum homocysteine levels and SBP, and to determine if homocysteine can serve as a potential biomarker for the early detection and follow-up of SBP.
Patients and methods: A prospective observational study included 60 patients diagnosed with post-HCV cirrhosis and ascites between May 2022 and May 2023. Participants were divided into two groups: Group I [n=30] consisted of patients without SBP, while Group II [n=30] included those with SBP. Clinical data, severity of hepatic decompensation via MELD and Child–Pugh scores, and laboratory and ascitic fluid analyses were collected. Serum homocysteine levels were measured using ELISA both at baseline and after five days of antibiotic treatment in the SBP cohort.
Results: Serum homocysteine levels were significantly higher in the SBP group before treatment [17.95 ± 5.89 vs. 12.55 ± 4.48, p=0.0002] and decreased after treatment [p=0.005]. ROC analysis indicated that serum homocysteine is a strong diagnostic biomarker [AUC=0.901] with high sensitivity [90.4%] and specificity [93.5%].
Conclusion: Serum homocysteine levels are significantly elevated in patients with spontaneous bacterial peritonitis, indicating its potential as a reliable biomarker for early diagnosis and assessment of liver status in cirrhotic patients.

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