Rapid Diagnosis of Spontaneous Bacterial Peritonitis Using Leukocyte Esterase Dipstick Testing

Abstract

Background: Ascitic fluid infection is presumptively diagnosed when the fluid polymorph nuclear (PMN) concentration equals or exceeds 250 cells /mic,l. The leukocyte esterase (lE) test has been shown to be a good predictor of the presence of PMNs in urine and other body fluids. this study examines of value of multistix 8SG dipstick test for rapid diagnosis of infected ascitic fluid.

Materials and Methods: Seventy three ascitic fluid samples were evaluated by PMN count and LE dipstick testing. LE dipstick values of small or greater were considered positive. For each samples the LE test result was compared to the corresponding PMN count.

Results: From 73 total patient (mean age: 55.1) they were 38 female (mean age: 46.4) & 35 male (mean age: 64.4). The causes of cirrhosis were HBV infection (39.7%), HCV infection (12.3%), Autoimmune hepatitis (9.6%), Cryptogenic (15%), other (4%) and Under evaluation (13%).The most finding in SBP negative group was asymptomatic (79%) but abdominal pain (77%) in SBP positive group. Eight of ten LE positive samples has PMN≥250 cells/mic,l while eight of nine samples with PMN≥250 cells/mic,l were also LE positive.Of 63 LE negative samples, 62 were also negative by PMN count. Sixty two of 64 samples with PMN‹250 cells/mic,l had negative LE test. The sensitivity and specificity of the LE test for detecting ascitic fluid PMN≥250 cells/mic,l were 88.8% (95% CI: 52-100%) and 97% (95% CI: 89-100%) respectively with a positive predictive value of 80%, a negative predictive value of 98.5%, and an accuracy of 95%.

Conclusion: The multistix leukocyte esterase test is useful for prompt detection of an elevated ascitic fluid PMN count, and recommended as a conveniant new method for the rapid diagnosis of infected ascitic fluid.