J Assoc Physicians India. 2023 Jan;71(1):1.
INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is a common and serious complication in cirrhosis patients with an incidence and mortality of about 30% and 25% respectively in hospitalised patients. Currently the diagnostic criteria is presence of >250 neutrophils per microlitre in ascitic fluid, but these facilities are not available at all timings and often the results are delayed. A rapid and bedside test is needed for diagnosis of SBP which aids in timely treatment.Dipsticks based on detection of leukocyte esterase in fluid are available everywhere and widely used for detecting urinary tract infection. In this study we aimed to find out the diagnostic utility of these dipsticks in SBP for immediate diagnosis.
MATERIALS: An observational cross sectional study was conducted among 75 patients with cirrhosis suspected of having SBP clinically. Relevant investigations, diagnostic paracentesis and dipstick test of ascitic fluid was done. The patients were divided into two groups with and without SBP.The ascitic fluid neutrophil count and dipstick results were compared in both groups.
RESULT: 26 patients (34.6%) had SBP out of total 75 patients. AKI and hepatic encephalopathy were significantly higher in SBP patients (53% and 50% respectively in SBP patients; 28% and 18% in patients without SBP). Sensitivity and specificity of dipstick test with cutoff of more than 1+ was 96% and 75% respectively; with cutoff of more than 2 was 80% and 91% respectively.
CONCLUSION: The dipstick can be used as a bedside maneuver for immediate diagnosis of SBP. Having a good negative predictive value, it can also be used to exclude SBP, thus avoiding unnecessary antibiotics administration. References Koulaouzidis A. Diagnosis of spontaneous bacterial peritonitis: an update on leucocyte esterase reagent strips. World J Gastroenterol 2011;17(9):1091-1094. Oey RC, Kuiper JJ, Van Buuren HR, et al. Reagent strips are efficient to rule out spontaneous bacterial peritonitis in cirrhotics. Neth J Med 2016;74(6):257-261.