The Periscreen Strip Is Highly Efficient for the Exclusion of Spontaneous Bacterial Peritonitis in Cirrhotic Outpatients.
We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP).



Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm3. Ascites not related to portal hypertension were excluded.



Overall, 649 patients from 21 French centers were included and 1,402 AF (803 AF samples from 315 outpatients and 599 samples from 334 inpatients) were assessed. Eighty-four AF samples (17 AF in 9 outpatients and 67 AF in 31 inpatients) were diagnosed as SBP. The prevalence of SBP was 6% (2.1% in outpatients vs. 11.2% in inpatients; P<0.001) and 7.2% in patients with symptoms suggestive of SBP (3% in outpatients vs. 11.3% in inpatients; P<0.001). The κ value for inter-reader agreement was 0.81 (95% confidence interval: 0.77-0.84) when using the "trace" threshold. Considering discordant results (n=131) as positive to interpret the diagnostic performance of the strip at the "trace" threshold, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.7, 57.1, 12.0, and 99.1%, respectively. At this "trace" threshold, sensitivity and NPV were both 100% in outpatients, and 89.5 and 97.9% in inpatients, respectively. At the "small" threshold, sensitivity, specificity, PPV and NPV were 81.0, 85.9, 25.9 and 98.7%, respectively.



The Periscreen strip is a rapid and highly efficient tool for excluding SBP in the outpatient setting.
Service d'Hépatologie et de Soins Intensifs Digestifs, hôpital Jean Minjoz, Besançon, France.
Thierry
T
Thévenot
Service d'Hépatologie et de Soins Intensifs Digestifs, hôpital Jean Minjoz, Besançon, France.
Charline
C
Briot
Service d'Hépato-Gastroentérologie, CHD-Vendée, La Roche sur Yon, France.
Vincent
V
Macé
Service d'Hépato-Gastroentérologie, de Nutrition et d'Alcoologie, GHPSO, Hôpital Laennec, Creil, France.
Hortensia
H
Lison
DHU UNITY, Service d'Hépatologie, Hôpital Beaujon, APHP, and Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy cédex, France.
Laure
L
Elkrief
Service d'Hépato-Gastroentérologie, hôpital Robert Debré, Reims cedex, France.
Alexandra
A
Heurgué-Berlot
Service d'Hépato-Gastroentérologie, hôpital Purpan, clinique Dieulafoy, Toulouse, France.
Christophe
C
Bureau
Service des Maladies du Foie, CHU Pontchaillou, Rennes, France.
Caroline
C
Jézéquel
Service d'Hépato-Gastroentérologie, hôpital de Rouen, Rouen, France.
Ghassan
G
Riachi
Service des Maladies de l'Appareil Digestif, CHRU de Lille, rue M. Polonovski, Lille cedex, France.
Alexandre
A
Louvet
Service d'Hépato-Gastroentérologie, Centre Hospitalier, Gonesse Cedex, France.
Arnaud
A
Pauwels
Service d'Hépato-Gastroentérologie et de nutrition, CHU Côte de Nacre, Caen, France.
Isabelle
I
Ollivier-Hourmand
INSERM U1065, hôpital universitaire de Nice, pôle digestif; Université de Nice-Sophia-Antipolis, Nice, France.
Rodolphe
R
Anty
Service d'Hépato-Gastroentérologie, hôpital Saint-Antoine, Paris cedex 12, France.
Nicolas
N
Carbonell
Service d'Hépato-Gastroentérologie, CH de Saint-Denis, Saint-Denis, France.
Hélène
H
Labadie
Service d'Hépato-Gastroentérologie, CH de Saint-Brieuc, St Brieuc, France.
Karim
K
Aziz
Service d'Hépato-Gastroentérologie, CH Bretagne-Atlantique, Vannes, France.
Denis
D
Grasset
Service d'Hépato-Gastroentérologie, hôpital d'Amiens, Amiens, France.
Eric
E
Nguyen-Khac
Service d'Hépato-Gastroentérologie, Hôpital de Cholet, Cholet, France.
Mehdi
M
Kaassis
Service d'Hépato-Gastroentérologie, hôpital de la Source, Orléans cedex 12, France.
Sofia
S
Hermann
Service d'Hépato-Gastroentérologie, CHU La-Cavale-Blanche, Brest, France.
Florence
F
Tanné
Service d'Hépato-Gastroentérologie, hôpital du Bocage, Dijon cedex, France.
Thomas
T
Mouillot
DHU UNITY, Service d'Hépatologie, Hôpital Beaujon, APHP, and Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Clichy cédex, France.
Olivier
O
Roux
Unité de Recherche Clinique, CHD-Vendée, La Roche sur Yon, France.
Aurélie
A
Le Thuaut
Service d'Hépatologie et de Soins Intensifs Digestifs, hôpital Jean Minjoz, Besançon, France.
Jean-Paul
JP
Cervoni
Service d'Hépato-Gastroentérologie, de Nutrition et d'Alcoologie, GHPSO, Hôpital Laennec, Creil, France.
Jean-François
JF
Cadranel
Service d'Hépato-Gastroentérologie, CHD-Vendée, La Roche sur Yon, France.
Matthieu
M
Schnee
D000368:Aged; D000553:Ambulatory Care; D001201:Ascites / Q000209:etiology*; D001202:Ascitic Fluid / Q000166:cytology*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology; D003124:Colorimetry; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007963:Leukocytes, Mononuclear / Q000166:cytology*; D008103:Liver Cirrhosis / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology; D019152:Paracentesis; D010538:Peritonitis / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity