[Usefulness of reagent strips for the diagnosis of spontaneous bacterial peritonitis].
OBJECTIVE
Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications for patients with liver cirrhosis, and it has a mortality rate of over 20%. Early diagnosis of SBP and immediate use of an adequate antibiotic therapy are very important for achieving a better prognosis. The aim of our study was to assess the usefulness of reagent strips for making the rapid diagnosis of SBP.


METHODS
A diagnostic paracentesis procedure was performed upon hospital admission in 257 cirrhotic patients (187 males, 70 females; mean age: 54 years) with ascites. Each fresh sample of ascitic fluid was tested using a reagent strip, and the result was scored as 0, 1+, 2+ or 3+. The leukocyte count, polymorphonuclear cell count, blood bottle culture, and chemistry of ascites were also done.


RESULTS
We diagnosed 79 cases of SBP and 2 cases of secondary bacterial peritonitis by means of the polymorphonuclear cell count and the classical criteria. When a reagent strip result of 3+ was considered positive, the test's sensitivity was 86% (70 of 81), the specificity was 100% (176 of 176), and the positive predictive value was 94%. Furthermore, when a reagent strip result of 2+ or more was considered positive, the test sensitivity was 100% (81 of 81), the specificity was 99% (174 of 176), and negative predictive value was 99%.


CONCLUSIONS
The use of reagent strips is a very sensitive and specific tool for the rapid diagnosis of SBP in cirrhotic patients. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
Kim
Dae-Kyoum
DK
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center.
Suh
Dong Jin
DJ
Kim
Gi Deog
GD
Choi
Won Beom
WB
Kim
Sung Hoon
SH
Lim
Young-Suk
YS
Lee
Han Chu
HC
Chung
Yong-Hwa
YH
Lee
Yung Sang
YS
D000368:Aged; D001202:Ascitic Fluid / Q000737:chemistry / Q000166:cytology; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D011237:Predictive Value of Tests; D011934:Reagent Strips; D012680:Sensitivity and Specificity
D011934:Reagent Strips