Abstract
Background: spontaneous bacterial peritonitis is the most frequent complication in HCV related liver cirrhosis causing significant mortality especially if there is a delay in diagnosis; the gold standard to diagnose spontaneous bacterial peritonitis (SBP) is a polymorphonuclear neutrophil count ≥ 250 cells/mm3 in ascitic fluid. This test is laborious and expensive. Urine reagent strips measuring leukocyte esterase activity have been proposed as a rapid and inexpensive alternative.
Aims: Is to emphasize the diagnostic accuracy of the Combi Stik leucocyte esterase reagent strips for rapid diagnosing SBP and to calculate the sensitivity, specificity, positive, and negative predictive values.
Methods and Material: The present study included 70 ascitic patients on top of Hepatitis C virus over a period of 5 months from June 2016 to October 2016. Patients with hepatitis B virus, cirrhosis due to any other cause or receiving antibiotics two weeks before the study were excluded. The included patient were then divided into SBP group including 50 patients and non SBP group including 20 patients according to the gold standard to diagnose SBP which is PMNLs ≥ 250 cells/ mm3 . The Combi stik reagent strips dipped in 5ml of each sample of ascitic fluid and read visually to compare the color.
Results: In comparable with the gold standard for diagnosing SBP which is PMNL≥ 250 cells/mm3 the using of Combi Stik leukocyte esterase reagent strips taking grade 3 as cutoff showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy (100%) with a very high statistically significance (P=<0.001) with a highly positive correlation. A negative result of leukocyte esterase test excludes SBP with a high degree of certainty.
Conclusions: The diagnostic accuracy of leukocyte esterase reagent strips, comparable with the gold standard test, was excellent for excluding and diagnosing SBP in an emergency, it can be used as an easy and rapid bedside test for diagnosing SBP sitting.
Keywords: Ascites, liver cirrhosis, spontaneous bacterial peritonitis, polymorphnuclear leukocytes, leukocyte esterase reagent strips.
References
1. Runyon BA. AASLD. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis. Hepatol 2013;57: 1651–3.
2. Koulaouzidis A. Diagnosis of spontaneous bacterial peritonitis:An update on leucocyte esterase reagent strips. World J Gastroenterol 2011; 17(9): 1091-4.
3. Garcia Tsao G. spontaneous bacterial peritonitis: historical perspective. J Hepatol 2004; 41:522-7.
4. Wong C, Holroyd-Leduc J, Thorpe K et al., Does this patient have bacterial peritonitis or portal hypertension? How do perform a paracentesis and analyze the results? JAMA 2008; 299:1166–78.
5. Bafandeh Y, Khodaei M. Evaluation of leukocyte esterase reagent strip test to detect spontaneous bacterial peritonitis in cirrhotic patients. Gastroenterology Insights. PAGE Press Publications; 2012 Jun 6;4(1):13.
6. Sithara K. Balagopal , Ashik Sainu ., Varghese Thomas. Evaluation of leucocyte esterase reagent strip test for the rapid bedside diagnosis of spontaneous bacterial peritonitis Indian J Gastroenterol 2010 (March–April):29(2):74–77
7. Braga LL, Souza MH, Barbosa AM et al., Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in northeastern Brazil by use of rapid urine-screening test. Sao Paulo Med J. 2006 May 4; 124(3):141-4.
8. Nguyen-Khac E, Cadranel JF, Thevenot T. Review article: the utility of reagent strips in the diagnosis of infected ascites in cirrhotic patients. Aliment Pharmacol Ther. 2008;28: 282-8.
9. Moorthy S., Chalasani V., Ramakrishnan S.R. et al., Efficiency Assessment of Leucocyte Esterase Reagent strips in rapid bedside diagnosis of Spontaneous Bacterial Peritonitis - a comparison study with the gold standard Absolute Neutrophil Counts in ascitic fluid. Indian journal of applied research 2015;5: 465-7.
10. Sapey T, Mena E, Fort E, et al., Rapid diagnosis of spontaneous bacterial peritonitis with leukocyte esterase reagent strip in a European and American center Journal of gastroenterolhepatol 2005;20;187-92
11. Fernandes S.R., Santos P., Fatela N. et al., Ascitic Calprotectin is a Novel and Accurate Marker for Spontaneous Bacterial Peritonitis. J. Clin. Lab. Anal. 2016; 30(6):1139-1145.
12. Oey R.C. , Kuiper J.J., Van Buuren H.R. et al., Reagent strips are efficient to rule out spontaneous bacterial peritonitis in cirrhotics. Netherlands J.of medicine 2016;74(6):257-261.
13. Hashemian A.M., Koorosh A., Moghaddam H.Z. et al., Diagnostic Value of Leukocyte Esterase Test Strip Reagents for Rapid Clinical Diagnosis of Spontaneous Bacterial Peritonitis in Patients Admitted to Hospital Emergency Departments in Iran.Iran Red Crescent Med J.2015;17(10): e 21341.
14. Kamal E. and Abdelhaleem H. Leukocyte esterase reagent (LER) strips: A rapid, easy and cheap test for the diagnosis of spontaneous bacterial peritonitis. MJMR, 2013;24(1):1-6.
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.106
