Spontaneous bacterial peritonitis in patients of cirrhosis of liver with ascites

Background : Spontaneous bacterial peritonitis (SBP) is commonest and severe complication of decompensated cirrhosis. 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/mm3 -irrespective of the AF culture result- is universally accepted nowadays as the best surrogate marker for diagnosing SBP. Without early antibiotic treatment, this complication is associated with high mortality rate, so early diagnosis and treatment of SBP is therefore necessary for survival. Leukocyte esterase dipstick test can rapidly diagnose the SBP. Aim : Objective of our study was to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis. Methods : This cross-sectional study was conducted from January 2013 to August 2013 at a tertiary care center in central India . All the Patients with cirrhosis and ascites of either gender were included in this study. A total of 104 patients were enrolled for the study. Patients with secondary bacterial peritonitis and those who have received antibiotic therapy during past 10 days of hospital admission were excluded from the study. All the patients underwent abdominal paracentesis. Urine dipstick (Piramal10x test-India) was used as screening test and the results were compared with manual cell counting and ascitic fluid culture. A cut-off of 4+ on dipstick test was considered as positive for SBP. Results : The manual cell count using the above criterion diagnosed 28.9% patients as having SBP. The dipstick results were compared with the PMN counts. Sensitivity, Specificity, Positive predictive value, Negative predictive value and accuracy was 83.3%, 95.9%, 89.3%, 93.4% and 92.3% respectively. Conclusion : Leukocyte esterase dipstick test emerged out as an effective tool for rapid, bedside diagnosis of SBP.