No abstract

The prevalence of ICP varies greatly according to country. The aim of this prospective study was to analyze the charac-The prevalence is high in Scandinavian countries (1%-teristics of intrahepatic cholestasis of pregnancy (ICP) in a 1.5%), 3,4 in Bolivia (9.2%), 5 and in Chile, with a prevalence French population. From 1989 to 1995 we studied 50 consecof between 11.8% and 27.6% according to ethnic origin. 6 In utive pregnant women with ICP (41 single, 7 twin, and 2Santiago the prevalence of ICP was recently evaluated at 4%. 7 triplet pregnancies) referred for hepatologic consultation. All In contrast, the prevalence is reported to be low in the United patients suffered from pruritus and/or jaundice associated States, 8 Canada, 9 and Switzerland. 10 In France the prevalence with elevated fasting serum levels of total bile acids (mean has been assessed to be 0.2% to 0.5% 11,12 and ICP has not 49 mmol/L, range 7-290). No patients had concomitant liver often been studied. disease and all recovered normal liver function after delivery.The aim of this prospective study was to analyze characterOverall prematurity rate was 60%: 100% in multiple pregnanistics of ICP in France. rently treated with cholestyramine), after decrease in dose ofSigns of pre-eclampsia, fever, and urinary or endocervical infection progesterone in 1 patient, and spontaneously in 2 patients.were exclusion criteria. In cases of recurrent ICP the first occurrence During the same period, the percentage of pregnant women during the period under study was taken into account for the dewithout ICP who had been treated with progesterone during scription of characteristics. pregnancy was statistically lower than the percentage of patients treated with progesterone before the onset of pruritus Methods in our group of patients with ICP (36% vs. 64%, P õ .01, Biological Tests. Fasting blood samples were taken and serum TBA odds ratio 3.16, 95% CI:1.29-7.80). These results suggest that and total bilirubin and conjugated bilirubin concentrations, and orally administered progesterone might be an exogenous fac-serum ALT, alkaline phosphatase (AP), and g-glutamyl transpeptitor which triggers ICP in predisposed women. (HEPATOLOGY dase (GGT) activity, were measured at least twice, for each patient. 1997;26:358-364.)In fact, this was usually once or twice a week until delivery. Serum aspartate aminotransferase (AST) and 5 nucleotidase activity was measured in 19 and 44 patients, respectively. Prothrombin time, Intrahepatic cholestasis of pregnancy (ICP) is a liver discreatininemia, and uricemia were also regularly monitored. For each ease unique to pregnancy, which occurs in the second or patient, the most abnormal values, i.e., the highest values for LFTs, third trimesters and disappears spontaneously after delivery. uricemia, creatininemia, and the lowest values for prothrombin timeThe occurrence of ICP carries a risk for the fetus and pruritus were retained for the calculation of the biological characteristics. is a very uncomfortable symptom for the mother. ...

Recent studies have shown that the diagnosis of spontaneous bacterial peritonitis (SBP) can be rapidly obtained using leukocyte esterase reagent strips. However, published studies were restricted to one or two centers, and the number of patients with SBP was thus limited. The aims of the current prospective multicenter study were: (1) to assess the diagnostic accuracy of the Multistix 8SG urine test for the diagnosis of SBP; and (2) to assess the prevalence of SBP. From January to May 2004, 2 reactive strips were tested independently in inpatients with cirrhosis and in outpatients undergoing paracentesis. Cultures of ascitic fluid were performed at the bedside using aerobic and anaerobic blood culture bottles. Two thousand one hundred twenty-three paracenteses were performed in 1,041 patients from 70 centers. One hundred seventeen samples, obtained from 91 patients, had ascites polymorphonuclear cell (PMN) counts >250/ l (range, 250-34,000), among which 56 were associated with positive ascitic fluid cultures. The prevalence of SBP was 5.5% in the whole population, 9% in inpatients, and 1.3% in outpatients (P < 0.0001). The prevalence of SBP was 0.57% in asymptomatic outpatients versus 2.4% in symptomatic outpatients (P ‫؍‬ 0.04). Using a threshold of 2؉ for positivity of the reagent strip, sensitivity was 45.3% for the diagnosis of SBP, specificity was 99.2%, positive predictive value was 77.9%, and negative predictive value was 96.9%. Conclusion: This study confirms the low prevalence of SBP in asymptomatic outpatients according to a priori defined criteria, and indicates an absence of diagnostic efficacy for this specific strip test. (HEPATOLOGY 2007;45:1275-1281

Leukocyte esterase reagent strips may provide a rapid bedside diagnosis of SBP and thereby shorten time to appropriate management. The Nephur-Test appeared to out-perform MultistixSG. These tests might be particularly useful in ambulatory settings or whenever ascites fluid analysis is not rapidly available.

Leukocyte esterase reagent strips may provide a rapid bedside diagnosis of SBP.