DIAGNOSTIC VALIDITY OF LEUKOCYTE ESTERASE DIPSTICK TEST FOR DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS
Abstract
Background: Spontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without anevident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis (SBP) is one ofthe severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, thiscomplication is associated with high mortality rate, so early diagnosis and treatment of SBP is thereforenecessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Objectives wereto find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneousbacterial peritonitis. Methods: This cross-sectional, validation study was conducted from January 2009to June 2009 at Medical Unit-II, Chandka Medical College Hospital Larkana. All the Patients withcirrhosis and ascites of either gender were included in this study. Paracentesis were performed onadmission. The ascitic fluid obtained at bedside was immediately tested with reagent strip Multistix® 10SG. Ascitic fluid was then analysed for PMN cell count. The result of reagent strip was compared withascitic fluid PMN cell count for determination of sensitivity, specificity, PPV and NPV of the test,while taking ascitic fluid PMN count ≥250/mm3 as standard for diagnosis of SBP. Leukocyte esterasedipstick read positive from +1 to +3 reaction while negative and trace reaction regarded as negative testresult. Results: Total ninety four patients were enrolled in this study. Ninety-four Ascitic fluid sampleswere obtained. SBP was diagnosed in 52 (55.3%) patients, 42 (44.7%) patients were negative for SBPby manual cell count. The sensitivity, specificity, PPV, NPV of leukocyte esterase dipstick test todiagnose SBP were 92%, 95%, 96%, 90% respectively. Conclusion: The leukocyte esterase dipsticktest can be used as rapid test for diagnosis of SBP due to its high diagnostic validity.Keywords: spontaneous bacterial peritonitis, ascites, cirrhosis, validity, leukocyte esterase.References
Rimola A, Garcia-Tsao G, Navasa M. Diagnosis, treatment and
prophylaxis of spontaneous bacterial peritonitis: a consensus
document. International Ascites Club. J Hepatol 2000;32:142–53.
Garcia-Tsao G. Current management of the complications of
cirrhosis and portal hypertension: variceal hemorrhage, ascites,
and spontaneous bacterial peritonitis. Gastroenterology
;120:726-48.
Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA,
Montano AA. Short-course versus long-course antibiotic
treatment of spontaneous bacterial peritonitis. A randomized
J Ayub Med Coll Abbottabad 2011;23(1)
http://www.ayubmed.edu.pk/JAMC/23-1/Nanik.pdf
controlled study of 100 patients. Gastroenterology
;100:1737–42.
Akriviadis EA, Runyon BA. Utility of an algorithm in
differentiating spontaneous from secondary bacterial peritonitis.
Gastroenterology 1990;98:27–33.
Jepsen P, Vilstrup H, Moller JK, Sorensen HT. Prognosis of
patients with liver cirrhosis and spontaneous bacterial peritonitis.
Hepatogastroenterology 2003;50:2133–6.
Siersema PD, de Marie S, van Zeijl JH, Bac DJ, Wilson JH.
Blood culture bottles are superior to Iysiscentrifugation tubes for
bacteriological diagnosis of spontaneous bacterial peritonitis. J
Clin Microbiol 1992;30:667–9.
Kutter D, Figueiredo G, Klemmer L. Chemical detection of
leukocytes in urine by means of a new multiple test strip. J Clin
Chem Clin Biochem 1987;25:91–4.
Moosa AA, Quortum HA, Ibrahim MD. Rapid diagnosis of
bacterial meningitis with reagent strips. Lancet 1995;345:1290–1.
Levy M, Tournot F, Muller C, Carbon C, Yeni P. Evaluation of
screening tests for urinary infection in hospital patients. Lancet
;2:384–5.
Sam R, Sahani M, Ulozas E, Leehey DJ, Ing TS, Gandhi VC.
Utility of a peritoneal dialysis leukocyte test strip in the diagnosis
of peritonitis. Artif. Organs 2002;26:546–8.
Mendler MH, Agarwal A, Trimzi M, Madrigal E, Tsushima
M, Joo E, et al. Developmental phase of a new point of service
test for spontaneous bacterial peritonitis (SBP) using a leukocyte
esterase method. Gastroenterology 2008;134:A792.
Nousbaum JB, Cadranel JF, Nahon P, Khac EN, Moreau R,
Thevenot T, et al. Diagnostic accuracy of the Multistix 8 SG
reagent strip in diagnosis of spontaneous bacterial peritonitis.
Hepatology 2007;45:1275–81.
Wisniewski B, Rautou PE, AI Sirafi Y, Lambare-Narcy B,
Drouhin F, Constantini D, et al. Diagnosis of spontaneous ascites
infection in patients with cirrhosis: reagent strips. Presse Med
;34:997–1000.
Vanbiervliet G, Rakotoarisoa C, Filippi J, Guerin O, Calle G,
Hastier P, et al. Diagnostic accuracy of a rapid urine-screening test
(Multistix8SG) in cirrhotic patients with spontaneous bacterial
peritonitis. Eur J Gastroenterol Hepatol 2002;14:1257–60.
Castellote J, Lopez C, Gornals J, Tremosa G, Farina ER,
Baliellas C, et al. Rapid diagnosis of spontaneous bacterial
peritonitis by use of reagent strips. Hepatology 2003;37:893–6.
Sapey T, Mena E, Fort E, Laurin C, Kabissa D, Runyon BA, et
al. Rapid diagnosis of spontaneous bacterial peritonitis with
leukocyte esterase reagent strips in a European and in an
American center. J Gastroenterol Hepatol 2005;20:187–92.
Thevenot T, Cadranel JF, Nguyen-Khac E, Tilmant L, Tiry C,
Welty S, et al. Diagnosis of spontaneous bacterial peritonitis in
cirrhotic patients by use of two reagent strips. Eur J Gastroenterol
Hepatol 2004;16:579–83.
Kim DY, Kim JH, Chon CY, Han KH, Ahn SH, Kim JK, et al.
Usefulness of urine strip test in the rapid diagnosis of
spontaneous bacterial peritonitis. Liver Int 2005;25:1197–201.
Sapey T, Kabissa D, Fort E, Laurin C, Mendler MH. Instant
diagnosis of spontaneous bacterial peritonitis using leukocyte
esterase reagent strips: Nephur-Test vs. MultistixSG. Liver Int
;25:343–8.
Butani RC, Shaffer RT, Szyjkowski RD, Weeks BE, Speights
LG, Kadakia SC. Rapid diagnosis of infected ascitic fluid using
leukocyte esterase dipstick testing. Am J Gastroenterol
;99:532–7.
Rajput MR, Zuberi BF, Sheikh WM, Solangi GA, Sheikh SM,
Sheikh GM. Frequency, microbial spectrum, clinical and
biochemical features of spontaneous bacterial peritonitis and its
variants. J Coll Physicians Surg Pakistan 1999;9:347–50.
Memon A Q,Memon G, Khaskheli A. Spontaneous bacterial
peritonitis in cirrhosis with ascites –An experience at PMCH,
Nawabshah. Med Channel 1999;5(1):31–4.
Jacobs JA, De Brauwer EI, Cornelissen EI, Drent M. Correlation
of leukocyte esterase detection by reagent strips and the presence
of neutrophils: a study in BAL fluid. Chest 2000;118:1450–4.
Yong WH, Southern JF, Pins MR, Warshaw AL, Compton CC,
Lewandrowski KB. Cyst fluid NB/70K concentration and
leukocyte esterase: two new markers for differentiating
pancreatic serous tumors from pseudocysts. Pancreas
;10:342–6.
Rindler-Ludwig R, Schmalzl F, Braunsteiner H. Esterases in
human neutrophil granulocytes: evidence for their protease
nature. Br J Haematol 1974;27:57–64.
Beer JH, Vogt A, Neftel K, Cottagnoud P. False positive results
for leucocytes in urine dipstick test with common antibiotics.
BMJ 1996;313:25.
Sarwar S, Alam A, Izhar M, Khan AA, Butt AK, Shafqat F et al.
Bedside diagnosis of spontaneous bacterial peritonitis using
reagent strips. J Coll Physicians Surg Pak 2005;15(7):418–21.
Downloads
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
