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Diagnosis of spontaneous bacterial peritonitis: an update on leucocyte esterase reagent strips
Abstract:
Ascites remain the commonest complication of decompensated cirrhosis. Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid (AF) in the absence of a contiguous source of infection and/or an intra-abdominal inflammatory focus. An AF polymorphonuclear (PMN) leucocyte count ≥ 250/mm(3)--irrespective of the AF culture result--is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Frequently the results of the manual or automated PMN count do not reach the hands of the responsible medical personnel in a timely manner. However, this is a crucial step in SBP management. Since 2000, 26 studies (most of them published as full papers) have checked the validity of using leukocyte esterase reagent strips (LERS) in SBP diagnosis. LERS appear to have low sensitivity for SBP, some LERS types more than others. On the other hand, though, LERS have consistently given a high negative predictive value (> 95% in the majority of the studies) and this supports the use of LERS as a preliminary screening tool for SBP diagnosis. Finally, an AF-tailored dipstick has been developed. Within the proper setting, it is set to become the mainstream process for handling AF samples.
Insights
Leukocyte esterase reagent strips (LERS) show low sensitivity for diagnosing spontaneous bacterial peritonitis (SBP) but offer a high negative predictive value. They can serve as a preliminary screening tool for SBP in patients with ascites.
Area of Science:
- Gastroenterology and Hepatology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Ascites is a common complication of decompensated cirrhosis, with spontaneous bacterial peritonitis (SBP) being a frequent infection.
- Diagnosis of SBP traditionally relies on ascitic fluid (AF) polymorphonuclear (PMN) leucocyte count ≥ 250/mm(3), a crucial but often delayed diagnostic marker.
- Timely diagnosis of SBP is critical for effective patient management and preventing severe complications.
Discussion:
- Leukocyte esterase reagent strips (LERS) have been evaluated in numerous studies since 2000 for SBP diagnosis.
- While LERS demonstrate low sensitivity for SBP, their consistently high negative predictive value (>95%) supports their utility as a preliminary screening tool.
- Certain LERS types exhibit better diagnostic performance than others.
Key Insights:
- LERS can effectively rule out SBP in a significant number of cases due to their high negative predictive value.
- The diagnostic accuracy of LERS for SBP is variable, with sensitivity being a limitation.
- A newly developed AF-tailored dipstick shows promise for routine use in managing ascitic fluid samples.
Outlook:
- Further validation and integration of AF-tailored dipsticks into clinical practice are anticipated.
- LERS may become a standard preliminary screening method for SBP, improving diagnostic workflows.
- Enhanced diagnostic tools for SBP could lead to earlier treatment initiation and improved patient outcomes.
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