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A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites

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Abstract

Background and Aims

Ascites with unknown cause remains a diagnostic challenge, which needs novel noninvasive biomarkers for the precise diagnosis. We aimed to evaluate the ascitic fluid and serum C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) as diagnostic markers in the differential diagnosis of malignant and benign ascites.

Methods

In this prospective work, 315 consecutive patients with ascites were studied. Ascitic fluid and serum levels of CRP and VEGF were evaluated by using an enzyme-linked immunosorbent assay.

Results

Patients were divided into a benign ascites group (group 1) (n = 256) and a malignant ascites group (group 2) (n = 59). Ascitic and serum CRP were significantly elevated in malignant ascites than benign ascites group [5.08 (3.62–6.58) vs. 1.82 (0.64–3.86) ng/ml; P < 0.001 and 12.7 (8.55–17.05) vs. 5.94 (2.57–10.64) ng/ml; P < 0.001], respectively. Ascitic and serum VEGF were significantly increased in malignant ascites than benign ascites patients [0.68 (0.39–0.96) vs. 0.41 (0.25–0.83) ng/ml; P < 0.001 and 0.74 (0.41–1.08) vs. 0.54 (0.23–0.86) ng/ml; P < 0.001], respectively. At a cutoff value of 7.3 and 0.63 ng/ml, serum CRP and VEGF had specificity (77.3 and 89.5 %) and sensitivity (83.1 and 94.9 %) for detecting malignant ascites [area under the curve (AUC) 0.821, 0.921], respectively. At a cutoff value of 2.5 and 0.57 ng/ml, ascitic CRP and VEGF had specificity (81.6 and 85.5 %) and sensitivity (84.7 and 91.5 %) for detecting malignant ascites (AUC 0.842, 0.894), respectively.

Conclusion

Elevated ascitic fluid and serum CRP and VEGF values were related to the malignant ascites.

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Abbreviations

CRP:

C-reactive protein

VEGF:

Vascular endothelial growth factor

AFI:

Ascitic fluid infections

SBP:

Spontaneous bacterial peritonitis

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Authors and Affiliations

  1. Tropical Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, 35516, Egypt

    Ahmed Abdel-Razik, Nasser Mousa & Hatem Elalfy

  2. Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt

    Tarek Fouad Sheta & Mahmoud Awad

  3. Nephrology and Dialysis Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt

    Mostafa Abdelsalam

  4. Clinical Pathology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt

    Rania Elhelaly & Rasha Elzehery

  5. Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University-Egypt, Mansoura, Egypt

    Nawal S. Gouda & Waleed Eldars

Authors
  1. Ahmed Abdel-Razik
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  2. Nasser Mousa
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  3. Hatem Elalfy
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  4. Tarek Fouad Sheta
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  6. Mostafa Abdelsalam
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  10. Waleed Eldars
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Correspondence to Ahmed Abdel-Razik.

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Abdel-Razik, A., Mousa, N., Elalfy, H. et al. A Novel Combination of C-Reactive Protein and Vascular Endothelial Growth Factor in Differential Diagnosis of Ascites. J Gastrointest Canc 48, 50–57 (2017). https://doi.org/10.1007/s12029-016-9873-x

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  • DOI: https://doi.org/10.1007/s12029-016-9873-x

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