Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Case Report Volume 3 Issue 11

Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Triggering Receptor Expressed on Myeloid Cells (TREM-1) as a Valid Marker

Nadia A Abdelkader1, Waheed Abd El Monsef1, Ahmed F Helal1, Ghada A Ismail2, Dalia H Abdelhamid2, Maha M El Gaafary3, Khaled Raafat4, Yasser A Abd El Razek1 and Ahmed Fouad Sherief1*

1Tropical Medicine Department, Ain Shams University, Cairo, Egypt
2Clinical Pathology Department, Ain Shams University, Cairo, Egypt
3Public Health and Community Medicine, Ain Shams University, Cairo, Egypt
4Internal Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo, Egypt

*Corresponding Author: Ahmed Fouad Sherief, Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt.

Received: September 24, 2020; Published: October 22, 2020



Purpose: Assessment of Triggering Receptor Expressed on Myeloid Cells (TREM-1) levels in the diagnosis of SBP and effectiveness of treatment among Egyptian cirrhotic ascitic patients.

Methods: This was a Prospective case-control study, which was conducted on 60 cirrhotic ascitic patients, and divided into two groups:

  • Group 1: (Control) 30 cirrhotic ascitic patients without SBP
  • Group 2: (SBP) 30 cirrhotic ascitic patients with SBP were admitted to the Tropical Medicine Department at Ain Shams University Hospitals with ascites due to chronic liver disease. All patients were subjected to a history of taking the clinical examination and laboratory investigations including ascitic fluid sampling for biochemical testing, total and predominant cell type, count of bacterial culture, and TREM-1 level.

Results: There was a high statistically significant difference between the two groups in the baseline level of TREM-1 while the mean was higher 1280 pg/ml (± 1136.9) with a level range between (580 - 4500 pg/ml) among patients with SBP Than the control group mean 129.9 pg/ml (± 51.9) with a level range between (60 - 250 pg/ml) among. Besides, it was found a statistically significant difference in the level of TREM-1 before and after treatment among patients with SBP. The mean of TREM-1 before treatment was higher 1280.6 pg/ml (± 1136.9) than a mean 376.2 pg/ml (± 78.4) and level range between (260 - 560 pg/ml) after the treatment.

Conclusion: TREM-1 is an easy, rapid, and reliable diagnostic tool for SPB which also harbors great value in following up patients with SBP.

Keywords: CLD; Ascites; Spontaneous Bacterial Peritonitis; Ascitic TREM-1 Level; Ascitic Culture



  1. Rimola A., et al. “Diagnosis, treatment, and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club”. Journal of Hepatology 1(2000): 142-153.
  2. Garcia-Tsao G. “Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis”. Gastroenterology3(2001): 726-748.
  3. Sugihara T., et al. “Rapid identification of bacterial species with bacterial DNA microarray in cirrhotic patients with spontaneous bacterial peritonitis”. Internal Medicine 1 (2009): 3-10.
  4. Runyon BA. “Management of adult patients with ascites due to cirrhosis”. Hepatology3 (2004): 841-856.
  5. Bouchon A., et al. “TREM-1 amplifies inflammation and is a crucial mediator of septic shock”. Nature 410 (2001): 1103.
  6. Allcock RJN., et al. “The human TREM gene cluster at 6p21.1 encodes both activating and inhibitory single IgV domain receptors and includes NKp44”. European Journal of Immunology2 (2003): 567-577.
  7. Arts RJW., et al. “TREM‐1: intracellular signaling pathways and interaction with pattern recognition receptors”. Journal of Leukocyte Biology2 (2013): 209-215.
  8. Begum NA., et al. “Mycobacterium Bovis BCG Cell Wall-Specific Differentially Expressed Genes Identified by Differential Display and cDNA Subtraction in Human Macrophages”. Infection and Immunity2 (2004): 937-948.
  9. Gibot S., et al. “A Soluble Form of the Triggering Receptor Expressed on Myeloid Cells-1 Modulates the Inflammatory Response in Murine Sepsis”. The Journal of Experimental Medicine11 (2004): 1419-1426.
  10. Ford JW and McVicar DW. “TREM and TREMlike receptors in inflammation and disease”. Current Opinion on Immunology1 (2009): 38-46.
  11. Gomez-Pina V., et al. “Metalloproteinases shed TREM-1 ectodomain from lipopolysaccharide-stimulated human monocytes”. Journal of Immunology6 (2007): 4065-4073.
  12. Mowa CT and Stanley AJ. “Review article: spontaneous bacterial peritonitis-diagnosis treatment and prevention”. Aliment Pharmacology Therapy12 (2001): 1851-1859.
  13. Ogutu EO. “Spontaneous bacterial peritonitis in patients with liver diseases and ascites as seen at Kenyatta National Hospital”. East African Medical Journal 4 (1988): 547-551.
  14. Ichou L., et al. “Ascitic fluid TREM-1 for the diagnosis of spontaneous bacterial peritonitis”. Gut 3 (2016): 536-538.
  15. Badran E. “Identification of bacterial pathogens in ascitic fluid from cirrhotic Egyptian patients by use of microbiological culture and PCR based methods”. (Thesis for MD degree of Tropical Medicine. Under the supervision of AlNaggar M, Abdella H, and Hefny Z (2017).
  16. Gines P., et al. “Management of cirrhosis and ascites”. The New England Journal of Medicine 350 (2004): 1646-1654.
  17. Kimmann M., et al. “Sustained impact of nosocomial-acquired spontaneous bacterial peritonitis in different stages of decompensated liver cirrhosis”. PLoS One8 (2019): e0220666.
  18. Mostafa MS., et al. “Detection of ascitic fluid infections in patients with liver cirrhosis and ascites”. Arabian Journal of Gastroenterology1 (2011): 20-24.
  19. Enomoto H., et al. “Diagnosis of spontaneous bacterial peritonitis and an in situ hybridization approach to detect an "unidentified" pathogen”. International Journal of Hepatology (2014): 634617.
  20. Amoako Duah and Kofi Nyaako Nkrumah. “Prevalence and predictors for spontaneous bacterial peritonitis in cirrhotic patients with ascites admitted at the medical block in Korle-Bu Teaching Hospital, Ghana”. Pan African Medical Journal 33 (2019): 35.
  21. Such J., et al. “Pathogenesis and clinical feature of spontaneous bacterial peritonitis”. In G. P. In: Arroyo V, Rodes J, Schrier RW, eds. (Ed.), Ascites and Renal Dysfunction in Liver Disease 2nd (2005): 422-434.


Citation: Ahmed Fouad Sherief., et al. "Spontaneous Bacterial Peritonitis in Cirrhotic Patients: Triggering Receptor Expressed on Myeloid Cells (TREM-1) as a Valid Marker". Acta Scientific Gastrointestinal Disorders 3.11 (2020): 23-27.


Acceptance rate35%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US