Accuracy of the automated cell counters for management of spontaneous bacterial peritonitis.
OBJECTIVE
To evaluate the accuracy of automated blood cell counters for ascitic polymorphonuclear (PMN) determination for: (1) diagnosis, (2) efficacy of the ongoing antibiotic therapy, and (3) resolution of spontaneous bacterial peritonitis (SBP).


METHODS
One hundred and twelve ascitic fluid samples were collected from 52 consecutive cirrhotic patients, 16 of them with SBP. The agreement between the manual and the automated method for PMN count was assessed. The sensitivity/specificity and the positive/negative predictive value of the automated blood cell counter were also calculated by considering the manual method as the "gold standard".


RESULTS
The mean +/- SD of the difference between manual and automated measurements was 7.8 +/- 58 cells/mm(3), while the limits of agreement were +124 cells/mm(3) [95% confidence interval (CI): +145 to +103] and -108 cells/mm(3) (95% CI: -87 to -129). The automated cell counter had a sensitivity of 100% and a specificity of 97.7% in diagnosing SBP, and a sensitivity of 91% and a specificity of 100% for the efficacy of the ongoing antibiotic therapy. The two methods showed a complete agreement for the resolution of infection.


CONCLUSIONS
Automated cell counters not only have a good diagnostic accuracy, but are also very effective in monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP.
Dipartimento di Medicina Clinica, Universita di Roma, Viale dell'Universita 37, Rome 00185, Italy. oliviero.riggio@uniroma1.it
Oliviero
O
Riggio
Stefania
S
Angeloni
Antonella
A
Parente
Cinzia
C
Leboffe
Giorgio
G
Pinto
Teresa
T
Aronne
Manuela
M
Merli
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000166:cytology* / Q000382:microbiology; D001331:Automation; D005260:Female; D006801:Humans; D007958:Leukocyte Count / Q000295:instrumentation*; D008103:Liver Cirrhosis / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000382:microbiology; D019152:Paracentesis; D010538:Peritonitis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents