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Arch Hellen Med, 29(5), September-October 2012, 606-613


Prevalence of spontaneous bacterial peritonitis in patients with cirrhosis of the liver
and evaluation of reagent strips in its diagnosis and follow-up

G. Nalmpantidis,1 D. Kapetanos,1 H. Taloumtzis,1 A. Garefas,1 A. Gantos,1 R. Kaba,1
E. Hatzopoulos,1 D. Polyzois,1 A. Tilkiridou,1 Z. Pelteki,2 A. Augerinos,1 T. Maris,1 A. Ilias1

1Gastroenterology Clinic,
2Department of Microbiology, "G. Papanikolaou" General Hospital, Thessaloniki, Greece

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.

© Archives of Hellenic Medicine