title: Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis.
abstract: 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>or=250/microl (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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Services d'Hépato-Gastroentérologie de, Brest, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France. jean-baptiste.nousbaum@chu-brest.fr
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Nousbaum
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cadranel
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.forename: Eric Nguyen
authors.initials: EN
authors.lastname: Khac
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.forename: Thierry
authors.initials: T
authors.lastname: Thévenot
authors.forename: Christine
authors.initials: C
authors.lastname: Silvain
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.forename: Olivier
authors.initials: O
authors.lastname: Nouel
authors.forename: Christophe
authors.initials: C
authors.lastname: Pilette
authors.forename: Thierry
authors.initials: T
authors.lastname: Paupard
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Thierry
authors.initials: T
authors.lastname: Davion
authors.forename: Vincent
authors.initials: V
authors.lastname: Jouannaud
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.forename: Sandrine
authors.initials: S
authors.lastname: Beaulieu
authors.forename: Odile
authors.initials: O
authors.lastname: Danne
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Carinne
authors.initials: C
authors.lastname: Chagneau-Derrode
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pauwels
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bronowicki
authors.forename: François
authors.initials: F
authors.lastname: Habersetzer
authors.forename: Armand
authors.initials: A
authors.lastname: Abergel
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Audigier
authors.forename: Thierry
authors.initials: T
authors.lastname: Sapey
authors.forename: Jean-Didier
authors.initials: JD
authors.lastname: Grangé
authors.forename: Albert
authors.initials: A
authors.lastname: Tran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D002265:Carboxylic Ester Hydrolases / Q000032:analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007958:Leukocyte Count; D016013:Likelihood Functions; D008103:Liver Cirrhosis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011934:Reagent Strips; D012680:Sensitivity and Specificity
chemical_list: D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases