Total ascitic fluid leukocyte count for reliable exclusion of spontaneous bacterial peritonitis in patients with ascites
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Published on: March 22, 2012
Björn-Christian Link1, Carsten G Ziske, Michael Schepke
1Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
Background And Aims:
The diagnosis of spontaneous bacterial peritonitis (SBP) in patients with ascites is established by definition with a polymorphonuclear (PMN) cell count in the ascitic fluid greater than 0.250 g/l determined via cytological (microscopic) examination. In this study, we correlated the automatically assessed total ascitic nucleated cell count with PMN and determined its predictive value for diagnosis of SBP.
Methods:
Six hundred and eleven consecutive paracenteses of 179 patients with ascites of various aetiologies (liver cirrhosis, hepatocellular carcinoma, peritoneal carcinomatosis, and ascites of other aetiology) were studied retrospectively.
Results:
The most reliable diagnostic cut-off level was determined for differentiation between SBP and non-SBP via receiver operating characteristics analysis. A total ascitic nucleated cell count less than 1.0 g/l is unlikely to represent SBP (negative predictive value, 95.5%).
Conclusions:
If ascitic fluid samples with machine-made total ascitic nucleated cell count below 1.0 g/l are not followed by additional laboratory tests, the risk of missing the diagnosis of SBP is low. Applying these criteria we would have classified 51 samples of 611 samples (20 of 179 patients) wrongly using the cut-off value of 1 g/l. On the other hand we would have spared cytologic evaluation in about 63% of paracentesis performed in our hospital. Nevertheless, to insure patient safety, standard laboratory analysis is recommended in circumstances of clinical uncertainty. Thus, patients with first manifestation of ascites should always receive cytologic examination and full diagnostic investigation to exclude other causes of ascites.
Insights
A low total ascitic nucleated cell count can help rule out spontaneous bacterial peritonitis (SBP) in ascites patients. This automated method may reduce unnecessary cytologic examinations for SBP diagnosis.
Area of Science:
- Gastroenterology
- Clinical Chemistry
- Laboratory Medicine
Background:
- Spontaneous bacterial peritonitis (SBP) diagnosis relies on ascitic fluid polymorphonuclear (PMN) cell count > 0.250 g/l via cytology.
- Automated cell counting offers a potential alternative for SBP diagnosis.
Purpose of the Study:
- To correlate automatically assessed total ascitic nucleated cell count with PMN count.
- To determine the predictive value of automated cell counts for SBP diagnosis.
Main Methods:
- Retrospective analysis of 611 paracenteses from 179 patients with various ascites etiologies.
- Receiver operating characteristics (ROC) analysis to determine diagnostic cut-off levels.
Main Results:
- A total ascitic nucleated cell count < 1.0 g/l has a 95.5% negative predictive value for SBP.
- This cut-off could potentially reduce cytologic evaluations by approximately 63%.
Conclusions:
- Automated total nucleated cell count < 1.0 g/l can reliably exclude SBP, reducing the need for further laboratory tests.
- While efficient, standard laboratory analysis is recommended in cases of clinical uncertainty.
- Cytologic examination remains crucial for initial ascites diagnosis and excluding other causes.
