Arch Hellen Med, 29(5), September-October 2012, 606-613
Prevalence of spontaneous bacterial peritonitis in patients with cirrhosis of the liver
G. Nalmpantidis,1 D. Kapetanos,1 H. Taloumtzis,1 A. Garefas,1 A. Gantos,1 R. Kaba,1
OBJECTIVE Prevalence estimation of spontaneous bacterial peritonitis (SBP) in inpatients and outpatients with cirrhosis of the liver in a tertiary care centre, and assessment of the diagnostic value of two types of reagent dipsticks (RD).
METHOD Prospective study was made of consecutive patients with cirrhotic ascites and ≥1 abdominal paracenteses who were enrolled over a 12-month period. Consecutive peritoneal fluid samples were analyzed with two types of RD (Aution 10A and Multistix® 10SG) and by microscopic examination (gold standard method), and the findings were compared.
RESULTS A total of 108 samples were tested from 43 patients (31 men, 72.1%), with a median age of 70 years. The Child-Pugh classification was: A: 32.6%, B: 39.5%, C: 27.9%. The most common causes of liver cirrhosis were alcohol abuse, viral hepatitis and non-alcoholic steatohepatitis. SBP prevalence was 13.95% (95% CI: 5.80−28.62%). Sensitivity (Se) and specificity (Sp) were 83.33% and 95.56% for the Aution and 64.29% και 100% for the Multistix, respectively. Positive (PPV) and negative predictive values (NPV) were 78.95% and 96.63% for the Aution and 100%, 92.42% for the Multistix, respectively. Accuracy (Ac) was 93.52% (Aution) and 93.33% (Multistix). In the follow-up, SBP samples Se, Sp, PPV, NPV and Ac were 90.90%, 81.80%, 83.30%, 90.00% and 86.00% for the Aution and 100%, 50.00%, 87.50%, 100% and 89.00% for the Multistix, respectively.
CONCLUSIONS Approximately 1 in 7 patients with cirrhotic ascites was diagnosed with SBP. RD showed high diagnostic value in the rapid diagnosis and follow-up of SBP and satisfactory agreement in the total (κ=0.74) and SBP follow-up samples (κ=0.61). When using Multistix® 10SG, a positive result should be considered 2+ (125 leukocytes/μL).
Key words: Cirrhosis, Diagnosis, Peritonitis, Reagent strips.