Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients in northeastern Brazil by use of rapid urine-screening test
Keywords:
Cirrhosis, Ascites, Diagnosis, Peritonitis, Reagent strips, UrinalysisAbstract
CONTEXT AND OBJECTIVE: Spontaneous bacte- rial peritonitis (SBP) is a frequent and severe complication of cirrhotic patients with ascites. It has been proposed that the reagent strip for leukocyte esterase designed for the testing of urine (Combur test® UX) could be a useful tool for diagnosing SPB. The aim of this study was to assess the sensitivity and specificity of urine test strips for diagnosing SBP in cirrhotic patients with ascites. DESIGN AND SETTING: Prospective study, at a university hospital in northeastern Brazil. METHODS: Forty-two unselected consecutive cirrhotic patients (32 males; mean age: 51.7 ± years) were included, and a total of 100 para- centeses were performed. All ascitic fluid samples were analyzed using the reagent strip and cytol- ogy, neutrophils, lymphocyte count, appropriate biochemical tests and culturing. The strips were considered positive if the color became purple on a colorimetric scale. RESULTS: Nine patients were diagnosed with SBP using cytology (> 250 neutrophils/mm3), and the strips were positive for all these nine patients with SBP. In one sample, the strip was positive but the neutrophil count was less than 250 cells/mm3. For 86 samples, both the strips and cytology were negative. At the threshold of 250 neutrophils/mm3 in ascitic fluid, the sensitivity, specificity, positive predictive value and negative predictive value for the strips were respectively 100%, 98.9%, 92.3% and 100%. CONCLUSION: The Combur test® UX urine screening test is a very sensitive and specific method for diagnosing SBP in cirrhotic patients with ascites.
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References
Rimola A. Infections in liver disease. In: McIntyre N, Ben- hamou JP, Bircher J, Rizetto M, Rodes J, editors. Oxford Textbook of Clinical Hepatology. Oxford: Oxford University Press; 1991. p. 1272–84.
Garcia-Tsao G. Spontaneous bacterial peritonitis. Gastroen- terol Clin North Am. 1992;21(1):257-75.
Caly WR, Strauss E. A prospective study of bacterial infections in patients with cirrhosis. J Hepatol. 1993;18(3):353-8.
Pinzello G, Simonetti R, Camma C, Dino O, Miazzo G, Pagliano L. Spontaneous bacterial peritonitis: an update. Gastroenterol Int. 1993;6:54-60.
Bac DJ, Siersema PD, Mulder PGH, DeMarie S, Wilson JHP. Spontaneous bacterial peritonitis: outcome and predictive factors. Eur J Gastroenterol Hepatol. 1993;5:635-40.
Llovet JM, Planas R, Morillas R, et al. Short-term prognosis of cirrhotics with spontaneous bacterial peritonitis: multivariate study. Am J Gastroenterol. 1993;88(3):388-92.
Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A random- ized controlled study of 100 patients. Gastroenterology. 1991;100(6):1737-42.
Toledo C, Salmeron JM, Rimola A, et al. Spontaneous bacterial peritonitis in cirrhosis: predictive factors of infection resolution and survival in patients treated with cefotaxime. Hepatology. 1993;17(2):251-7.
Thuluvath PJ, Morss S, Thompson R. Spontaneous bacterial peritonitis--in-hospital mortality, predictors of survival, and health care costs from 1988 to 1998. Am J Gastroenterol. 2001;96(4):1232-6.
Rimola A, Garcia-Tsao G, Navasa M, et al. Diagnosis, treat- ment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. 2000;32(1):142-53.
Rimola A, Salmeron JM, Clemente G, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology. 1995;21(3):674-9.
Navasa M, Follo A, Llovet JM, et al. Randomized, com- parative study of oral ofloxacin versus intravenous cefo- taxime in spontaneous bacterial peritonitis. Gastroenterology. 1996;111(4):1011-7.
Runyon BA, Hoefs JC. Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology. 1984;4(6):1209-11.
Terg R, Levi D, Lopez P, et al. Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease. Dig Dis Sci. 1992;37(10):1499-504.
Runyon BA, Canawati HN, Akriviadis EA. Optimiza- tion of ascitic fluid culture technique. Gastroenterology. 1988;95(5):1351-5.
Lejeune B, Baron R, Guillois B, Mayeux D. Evaluation of a screening test for detecting urinary tract infection in newborns and infants. J Clin Pathol. 1991;44(12):1029-30.
Kutter D, Figueiredo G, Klemmer L. Chemical detection of leukocytes in urine by means of a new multiple test strip. J Clin Chem Clin Biochem. 1987;25(2):91-4.
Hiscoke C, Yoxall H, Greig D, Lightfoot NF. Validation of a method for the rapid diagnosis of urinary tract infec- tion suitable for use in general practice. Br J Gen Pract. 1990;40(339):403-5.
López Parades A, Valera Mortón C, Ródenas García V, Pe- dromingo Marino A, Martínez Hernández P. Estudio de la zona de leucocitos de la tira reactiva Multistix-10-SG en líquidos cefalorraquídeo, seminal y peritoneal. [The leukocyte zone on Multistix-10-SG reactive strips for cerebrospinal, seminal and peritoneal fluids]. Med Clin (Barc). 1988;90(9):362-5.
Castellote J, Lopez C, Gornals J, et al. Rapid diagnosis of spontaneous bacterial peritonitis by use of reagent strips. Hepatology. 2003;37(4):893-6.
Thevenot T, Cadranel JF, Nguyen-Khac E, et al. Diagnosis of spontaneous bacterial peritonitis in cirrhotic patients by use of two reagent strips. Eur J Gastroenterol Hepatol. 2004;16(6):579-83.
Vanbiervliet G, Rakotoarisoa C, Filippi J, et al. Diagnostic accuracy of a rapid urine-screening test (Multistix8SG) in cirrhotic patients with spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol. 2002;14(11):1257-60.
Fernandez J, Navasa M, Gomez J, et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology. 2002;35(1):140-8.
Rimola A, Salmeron JM, Clemente G, et al. Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study. Hepatology. 1995;21(3):674-9.
Navasa M, Follo A, Filella X, et al. Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality. Hepatology. 1998;27(5):1227-32.
