DIAGNOSTIC VALUE OF SOME INFLAMMATORY MARKERS OF AS EARLY PREDICTORS OF ACUTE PERITONITIS IN PATIENTS WITH HIV INFECTION

Background. The course of peritonitis in HIV-infected patients is blurred and its diagnosis is not always easy, which determines the urgency of searching for potential laboratory predictors. Purpose. Assessment of the diagnostic value of leukocyte levels, neutrophil-lymphocyte ratio (NLR), procalcitonin and C-reactive protein as predictors of acute peritonitis in patients with HIV infection. Materials and methods. The study included 158 HIV-infected patients with a preliminary diagnosis of acute peritonitis. Before surgery, leukocytes, procalcitonin, and C-reactive protein, as well as the immune status and viral load of HIV RNA, were determined in the peripheral blood of patients, and NLR were calculated. All patients underwent diagnostic laparoscopy, according to the results of which they were divided into the main and control groups. 83 patients were selected in the main group, in whom the diagnosis of acute peritonitis was confirmed. The control group included 75 patients whose diagnosis of acute peritonitis was not confirmed. Depending on the results of the immune status, the patients in each group are divided into four subgroups. The analysis of the diagnostic value of leukocyte levels, NLR, procalcitonin and C-reactive protein indicators as predictors of acute peritonitis in patients with HIV infection was carried out and the dependence of these inflammatory markers on immune deficiency and the severity of the viral load of HIV RNA was studied. Results. There is a direct dependence of the leukocyte level on the immune status of the studied category of patients. The sensitivity and specificity of this laboratory test in the diagnosis of acute peritonitis are of low importance. The indicators of procalcitonin and C-reactive protein when compared in the main and control groups did not correlate with the severity of immunodeficiency. When studying the diagnostic test data, excellent quality of the data analysis model, high sensitivity and specificity indicators were obtained. The study shows that NLR do not correlate with the level of immune status, however, only a satisfactory quality of the data analysis model was obtained, and sensitivity and specificity have the lowest values in the presented study. The thresholds of this indicator in the study cohort are also not completely clear, since half of the patients in the control group exceeded the cut-off point obtained as a result of the ROC-analysis. Conclusions. The level of peripheral blood leukocytes in the diagnosis of acute peritonitis in people living with HIV is of minor importance. The role of the NLR indicator in the studied category of patients is not entirely clear, and additional research is needed for its effective use in the diagnosis of acute peritonitis in patients with HIV infection. Procalcitonin and C-reactive protein can be used as laboratory predictors of acute peritonitis in HIV-positive patients.