Diagnosis of spontaneous bacterial peritonitis in patients with chronic liver disease: Role of leukocyte esterase dipstick test.

Abstract

Objective: To find out the efficiency of leukocyte esterase reagent strip (LERS) testing for the diagnosis of spontaneous bacterial peritonitis (SBP). Study Design: Cross Sectional, Validation study. Setting: Department of Medicine, Unit-III, Bahawal Victoria Hospital, Bahawalpur. Period: January-December 2019. Material & Methods: A total of 235 patients of both gender, aged 18-60 years, having CLD with ascites, with any child pugh class and duration of CLD between 6-12 months were enrolled. Ascitic fluid was obtained at bedside and immediately dispatched for testing in a clean and dry test tube with reagent strip Multistix® 10 SG. Screening tests were calculated for accuracy of LERS test with respect to confirmed cytology testing. Results: Majority, 152 (64.7%) were male, 94 (40.0%) between 51-60 years age group and 146 (62.1%) had child pugh class C. Overall, mean age was noted to be 46.82+9.45 years. LERS testing turned out to be positive among 138 (5837%) cases. Confirmation of SBP through cytology was noted among 141 (60.0%). Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of LERS for the diagnosis of SBP with respect to cytology confirmation was calculated to be 90.8%, 89.4%, 92.8%, 86.6% and 90.2% respectively. Conclusion: The LERS testing was found to have high SE, SP, PPV, NPV and diagnostic accuracy in diagnosing SBP among patients of CLD with ascites. LERS can be used at bedside while it very simple and easy to perform.