Evaluation of calprotectin level, thiol-disulfide balance and oxidative stress parameters in the differential diagnosis of ascitic fluids

Aim: Pathological fluid accumulation in the peritoneal cavity caused by many common diseases such as cirrhosis, cancer and heart failure is called ascites. The serum-acid albumin gradient is the most frequently used different diagnostic parameter to eliminate the diagnostic difficulty in the etiology of ascites. In the method to be used; High diagnostic accuracy, sensitivity and specificity, and being easy and cheap are among the sought-after features. The aim of this study is to measure calprotectin, thiol-disulfide, total oxidant and total antioxidant levels in ascites fluid and to investigate their usability in the differential diagnosis of ascites. Methods and Equipment: 88 patients who were diagnosed with abdominal ascites and underwent paracentesis in the Gastroenterology service of Harran University Faculty of Medicine Hospital were prospectively included in the study. Patients with minimal ascites in the abdomen and those who could not undergo paracentesis and those using vitamin supplements and antioxidant drugs were excluded from the study. Ascites staging was grade 1 (mild), grade 2 (moderate), grade 3 (severe), with the staging recommended by the International Ascites Club. Patients with grade 1 ascites underwent ultrasound guidance, and patients with grade 2-3 ascites underwent physical examination and paracentesis was performed in a sterile manner using a thick-tipped needle. These acid samples were stored at -40°C. Glucose, albumin, lactate dehydrogenase, total protein, hemogram, calprotectin, thiol-disulfide, total antioxidant and total oxidant parameters were studied in ascitic fluid. Statistical analyzes were performed using the SPSS program. Consent was obtained from the patients participating in the study by informing them with informed consent forms, it was carried out in accordance with the principles of the Declaration of Helsinki, and approval was obtained from the Clinical Research Ethics Committee of Harran University Faculty of Medicine. Findings: 88 of the patients included in the study, 56 (63.6%) were female and 32 (36.4%) were male, and the average age was 60.43 ± 18 (range 16-87) years. While 50 (56.8%) patients had portal type and 38 (43.2%) patients had non-portal type acid, 60 (68.2%) of the patients were non-malignant and 28 (31.8%) were malignant. In the portal type ascites group, the average calprotectin value was 17.49 ± 2.72 ng/mL, TAS value was 1.03 ± 0.15, TOS value was 15.34 ± 5.47, OSI value was 1.55 ± 0.73, while SS/SH ratio was 5.01 ± 2.25, the SS/TT ratio was 4.48 ± 1.79, the SH/TT ratio was 91.02 ± 3.58, the average calprotectin value in the non-portal type ascites group was 23.83 ± 5, 01 ng/mL, TAS value 0.81 ± 0.25, TOS value 17.45 ± 4.08, OSI value 2.60 ± 2.28, SS/SH ratio 6.93 ± 2.32, SS/TT ratio was 6.02 ± 1.77, SH/TT ratio was 87.95 ± 3.55 (p<0.001). When the etiological causes of ascites are grouped as malignant and non-malignant, the average calprotectin value in non-malignant ascites is 17.63 ± 3.062 ng/mL, TAS value is 1.04 ± 0.18, TOS value is 15.11 ± 5.20, OSI value is 1.53 ± 0.71, SS/SH ratio is 5.25 ± 2.24, SS/TT ratio is 4.68 ± 1.78, SH/TT ratio is 90.6 ± 3.5, while the avarage calprotectin value in malignant ascites is 25.8 ± 3.51 ng/mL, TAS value 0.72 ± 0.17, TOS value 18.7 ± 3.53, OSI value 3.03 ± 2.51, SS/SH ratio 7.11 ± 2, 47, SS/TT ratio was 6.14 ± 1.89, while SH/TT ratio was 87.7 ± 3.7 (p<0.001). When the cut-off value of calprotectin in malignant ascitic fluid was taken as 20.68 ng/mL, it had 92.8% sensitivity and 93% specificity, but the sensitivity and specificity rates in other parameters were low. Conclusion: Calprotectin, as well as TAS, TOS, OSI, SH, TT, SS, SS/SH, SS/TT and SH/TT values, make an important contribution to the differential diagnosis of ascites in the distinction between portal and non-portal and malignant and non-malignant. Acid calprotectin level shows high sensitivity and specificity in distinguishing malignant and non-malignant. Key Words: Acid, malignancy, thiol-disulfide, calprotectin, oxidative stress