Diagnostic efficacy of leukocyte esterase dipstick in diagnosing spontaneous bacterial peritonitis among cirrhotic patients in tertiary hospitals, Dodoma, Tanzania

Abstract

BackgroundSpontaneous bacterial peritonitis (SBP) is complications of end stage liver disease, it associated with morbidity and mortality, the gold standard for diagnosing SBP is an ascitic fluid Polymorphonuclear neutrophil count (PMN) of ≥ 250 cells/mm3, this examination is time consuming and costly. Urine reagent dipstick detecting leukocyte esterase activity has been suggested as quick and affordable substitute. The purpose of this study was to evaluate the CYBOW™ 10 strip’s ability to diagnose SBP.MethodsA Crossectional analytical study was conducted from November 2022 to June 2023. 224 patients with confirmed cirrhotic ascites, aged ≥ 18 years and met inclusion criteria were recruited in the study. By following sterile procedure ascitic fluid was collected, bedside ascitic fluid examination by CYBOW™ 10 reagent strips, and the samples for cytological examination were taken. Ascitic fluid with PMN ≥ 250cells/mm3was considered positive for SBP, and +1 to +3 of CYBOW™ 10 reagent strip, was used as cut off levels for a positive SBP. By using SPSS version 25, 2 by 2 table was applied to determine the sensitivity (Sn), Specificity (Sp), Positive Predictive value (PPV), and Negative Predictive Value (NPV), and Receiver Operating Characteristic (ROC) was applied to determine the area under the curve of the leukocyte esterase dipstick.ResultsOn the basis of the ascitic fluid PMN count, 42 (18.75%) individuals had SBP. At cut-off point of +2 CYBOW™ 10 urine reagent strip had Sensitivity of 82.14%, Specificity of 99.39%, PPV of 95.83% and NPV of 96.79%, with AUC of 0.9074.ConclusionCYBOW™ 10 reagent strip test might be a helpful tool for doctors, when a rapid cell count for SBP diagnosis is not available. These strips are readily available and inexpensive, can be very helpful in areas with low resources and to patients who are unable to pay for cytology.