Performance of Fecal Calprotectin and Serum Procalcitonin for the Diagnosis of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Prospective Diagnostic Accuracy Study

Authors

• Mandip Singh Bhatia
• Devarakonda Uday Teja
• Nipun Verma
• Archana Angrup
• Saurabh Chandrabhan Sharda

Language

English

Publication Date

7-1-2026

Journal

Saudi Journal of Gastroenterology

DOI

10.4103/sjg.sjg_426_25

PMID

41746298

PMCID

PMC13441240

PubMedCentral® Posted Date

2-26-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Background:: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with cirrhosis and ascites. This study aimed to evaluate the diagnostic performance of biomarkers—calprotectin (serum, ascitic, fecal) and serum procalcitonin (PCT)—for SBP.

Methods:: This prospective diagnostic accuracy study, enrolled 137 consecutive patients with cirrhosis and ascites at a tertiary care center in India. Participants were categorized into SBP (n = 55) and non-SBP (n = 82) groups based on the reference standard of ascitic fluid neutrophil count. Serum, ascitic fluid, and fecal calprotectin were measured by enzyme-linked immunosorbent assay, and serum PCT was measured by electrochemiluminescence immunoassay. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). Mortality was assessed at 3 months.

Results:: Patients in the SBP group had significantly higher median levels of serum PCT (0.95 μg/L vs. 0.46 μg/L; P = 0.001) and fecal calprotectin (50.00 μg/g vs. 20.00 μg/g; P < 0.001) compared to the non-SBP group. Fecal calprotectin demonstrated excellent diagnostic accuracy for SBP with an AUROC of 0.857 (95% confidence interval [CI]: 0.785–0.929), followed by serum PCT with an AUROC of 0.662 (95% CI: 0.565–0.759). An optimal cut-off of >33 μg/g for fecal calprotectin and >0.83 μg/L for serum PCT were identified. A predictive model incorporating serum PCT and fecal calprotectin achieved an AUROC of 0.862 (95% CI: 0.792–0.932). Three-month mortality was higher in the SBP group, though not statistically significant (41.5% vs. 32.1%; P = 0.276).

Conclusion:: Fecal calprotectin and serum PCT are promising, readily measurable biomarkers for the diagnosis of SBP in patients with cirrhosis.

Keywords

Ascites, calprotectin, cirrhosis, procalcitonin, spontaneous bacterial peritonitis

Published Open-Access

yes

Recommended Citation

Bhatia, Mandip Singh; Teja, Devarakonda Uday; Verma, Nipun; et al., "Performance of Fecal Calprotectin and Serum Procalcitonin for the Diagnosis of Spontaneous Bacterial Peritonitis in Patients With Cirrhosis: A Prospective Diagnostic Accuracy Study" (2026). Faculty, Staff and Students Publications. 8294.
https://digitalcommons.library.tmc.edu/baylor_docs/8294