SPONTANEOUS BACTERIAL PERITONITIS

EVALUATION OF ROLE OF ASCITIC FLUID LACTATE DEHYDROGENASE IN DIAGNOSIS

Abstract

Objectives: To find out the diagnostic accuracy of ascitic fluid Lactate
Dehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absolute
neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design:
Cross sectional (validation) study. Setting: This study was conducted in department of
Medicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting after
approval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluid
was withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cell
count, total protein, albumin and LDH wascalculated along with serum albumin and serum
LDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer,
serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin from
serum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratio
was calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derived
from total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years,
53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standard
was recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenase
in diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count
equal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%,
88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictive
value and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negative
likelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluid
Lactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using ascitic
fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard.