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Diagnosis of Spontaneous Bacterial Peritonitis with Dipstick Test
Uppula Supriya1, KTripathi1, Akhil Jinda1
1Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, Delhi, India.
Introduction:
Spontaneous bacterial peritonitis (SBP) is a common and serious complication in cirrhosis patients with an incidence and mortality of about 30% and 25% respectively in hospitalised patients. Currently the diagnostic criteria is presence of >250 neutrophils per microlitre in ascitic fluid, but these facilities are not available at all timings and often the results are delayed. A rapid and bedside test is needed for diagnosis of SBP which aids in timely treatment.Dipsticks based on detection of leukocyte esterase in fluid are available everywhere and widely used for detecting urinary tract infection. In this study we aimed to find out the diagnostic utility of these dipsticks in SBP for immediate diagnosis.
Materials:
An observational cross sectional study was conducted among 75 patients with cirrhosis suspected of having SBP clinically. Relevant investigations, diagnostic paracentesis and dipstick test of ascitic fluid was done. The patients were divided into two groups with and without SBP.The ascitic fluid neutrophil count and dipstick results were compared in both groups.
Result:
26 patients (34.6%) had SBP out of total 75 patients. AKI and hepatic encephalopathy were significantly higher in SBP patients (53% and 50% respectively in SBP patients; 28% and 18% in patients without SBP). Sensitivity and specificity of dipstick test with cutoff of more than 1+ was 96% and 75% respectively; with cutoff of more than 2 was 80% and 91% respectively.
Conclusion:
The dipstick can be used as a bedside maneuver for immediate diagnosis of SBP. Having a good negative predictive value, it can also be used to exclude SBP, thus avoiding unnecessary antibiotics administration. References Koulaouzidis A. Diagnosis of spontaneous bacterial peritonitis: an update on leucocyte esterase reagent strips. World J Gastroenterol 2011;17(9):1091-1094. Oey RC, Kuiper JJ, Van Buuren HR, et al. Reagent strips are efficient to rule out spontaneous bacterial peritonitis in cirrhotics. Neth J Med 2016;74(6):257-261.
Insights
Leukocyte esterase dipsticks offer a rapid, bedside method for diagnosing spontaneous bacterial peritonitis (SBP) in cirrhosis patients. This test aids in timely treatment and can help rule out SBP, preventing unnecessary antibiotic use.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Diagnostics
Background:
- Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhosis patients, with high incidence and mortality.
- Current diagnostic methods for SBP rely on ascitic fluid neutrophil counts, which are often delayed and not universally available.
- There is a critical need for rapid, bedside diagnostic tools for SBP to enable prompt treatment.
Purpose of the Study:
- To evaluate the diagnostic utility of leukocyte esterase dipsticks for the immediate diagnosis of SBP in cirrhosis patients.
- To assess the feasibility of using dipstick tests as a bedside maneuver for SBP diagnosis.
Main Methods:
- An observational cross-sectional study involving 75 cirrhosis patients with suspected SBP.
- Diagnostic paracentesis and ascitic fluid analysis, including neutrophil count and leukocyte esterase dipstick testing.
- Comparison of dipstick results with ascitic fluid neutrophil counts to determine diagnostic accuracy.
Main Results:
- SBP was diagnosed in 34.6% of the patients studied.
- The dipstick test demonstrated high sensitivity (96%) and specificity (91%) at a cutoff of >2+ for SBP diagnosis.
- AKI and hepatic encephalopathy were significantly more prevalent in patients with SBP.
Conclusions:
- Leukocyte esterase dipstick tests are effective as a bedside tool for the rapid diagnosis of SBP.
- The test's high negative predictive value allows for the exclusion of SBP, thereby avoiding unnecessary antibiotic administration.
- Implementing dipstick testing can significantly improve the management of SBP in cirrhosis patients.
