Evaluation of leukocyte esterase reagent strip test to detect spontaneous bacterial peritonitis in cirrhotic patients

Abstract

Spontaneous bacterial peritonitis (SBP) is a frequent and sever complication of cirrhotic patients with ascites. The aim of this study was to assess diagnostic value of leukocyte esterase reagent strip test (Medi-Test Combi) for the rapid diagnosis of SBP in cirrhotic patients with ascites in the University Hospital of Imam Reza in Tabriz, Iran. In this study, 132 consecutive samples from cirrhotic patients who underwent abdominal paracentesis were evaluated. These samples were tested by 3 methods: i) manual cell count with differential study, SBP was defined as having poly-morphonuclear cells count of ≥250/mm3; ii) culture of ascetic fluid samples; iii) all samples were tested by leukocyte esterase dipsticks. The sensitivity, specificity, positive and negative predictive values of two different colorimetric cut-off scales (1+ and 2+) were calculated and compared. The sensitivity, specificity, positive and negative predictive values of 1+ and 2+ cut-off scales to diagnose SBP were 97.5%, 84.6%, 74% and 98.7% for the 1+ cut-off scale and 87.8%, 96.7%, 92.3% and 94.6% for the 2+ cut-off scale. Leukocyte esterase reagent strip test can be used as a rapid test for screening of SBP. The higher cut-off colorimetric scale has a better specificity and positive predictive value but a lower sensitivity

Tow Minutes to Exclude or Diagnose SBP Using Leucocyte Esterase Reagent Strip

“…Our results were superior to this study for utilization of LE strips in rapid diagnosis of SBP this may be attributed to the type of reagent strip we used with lower grade scale (4 grades). Bafandeh has evaluated the diagnostic value of LE reagent strips on 132 patient with cirrhosis and ascites using (Medi-Test combi, France) and the results showed that sensitivity, specificity, PPV and NPV of leukocyte esterase reagent strip test were 97.5%, 84.6%, 74% & 98.7% respectively (5) . Our results were slightly similar according to sensitivity and NPV and superior according to specificity and PPV.…”

“…Considering the mortality from SBP, this test will help to improve the management of SBP. It has been proposed that reagent strip testing for leukocyte esterase is rapid and could be utilized to reduce the time between performing paracentesis and obtaining a presumptive diagnosis of SBP from a few hours to a few seconds (5) . Moreover, such strips would be available everywhere, are easy to use, do not require expertise, thereby allowing antibiotic therapy to be immediately started (6) .…”

Identifying high and low serum-ascites albumin gradient in ascitic fluid by the point of care dipstick test

“…Point of care examination of the ascitic fluid by urinary dipstick was studied extensively by some investigators, but their focus was mainly maintained on detecting infections (namely, spontaneous bacterial peritonitis [SBP]) rather than differentiating between high and low values of SAAG (8)(9)(10)(11). Some studies found acceptable accuracy for dipstick tests (leukocyte esterase) to detect peritonitis in ascitic fluid (12,13), whereas other studies (including the largest one) concluded that dipstick test does not have sufficient sensitivity to detect SBP (14,15). The focus of previous studies on dipstick tests for ascetic fluid was perhaps due to the fact that a rapid diagnosis of SBP would be useful in initiating a suitable empirical antibiotic awaiting the results of culture.…”