Abstract
PICO question
 Can the measurement of blood and peritoneal fluid effusion glucose levels be used to accurately diagnose septic peritonitis in dogs when compared to cytology and bacterial culture?
 
 Clinical bottom line
 Category of research question
 Diagnosis
 The number and type of study designs reviewed
 Three papers were critically reviewed, all of which were diagnostic test evaluation studies
 Strength of evidence
 Moderate
 Outcomes reported
 Glucose measurements can be used to diagnose septic peritonitis when the blood plasma glucose level is >2.1 mmol/L higher than that of the peritoneal fluid glucose when using a veterinary point of care (POC) glucometer. If using a biochemistry analyser, a whole blood glucose >1.1 mmol/L higher than that of the peritoneal fluid can be used to diagnose septic peritonitis. This is only relevant when the peritoneal fluid is collected by abdominocentesis and not in a postoperative period
 Conclusion
 At present, there is moderate evidence that glucose measurements are useful as a patient side test for the diagnosis of septic peritonitis and are especially useful in cases where intracellular bacteria cannot be identified on cytology. However, despite the so far promising accuracy results, the cut-offs reported are quite variable and overall, there is not a single diagnostic test that is 100% sensitive and specific in repeated studies. Therefore, the results of the glucose measurements should be evaluated alongside other biomarker testing, imaging modalities and the clinical presentation of the patient. Glucose measurements cannot currently replace culture / sensitivity and cytology as the gold standard for the diagnosis of septic peritonitis
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
Intervention details: Minimum of 1 ml of venous blood and 1 ml of peritoneal effusion collected from all patients and placed into heparinised tubes
This study identified a diagnostic sensitivity and specificity of 100% when using blood to fluid glucose (BFG) differences of >1.1 mmol/L to diagnose septic peritonitis (SP) (Bonczynski et al, 2003)
This study identified that blood-effusion gradients were higher in dogs with SP compared to nonseptic ascites (NSA) and this was a statistically significant difference
Summary
Population: Mixed population of dogs and cats with naturally occurring peritoneal effusions, presenting at a referral practice. Sample size: 18 dogs: Seven septic peritoneal effusions 11 nonseptic peritoneal effusions (control group). Intervention details: Minimum of 1 ml of venous blood and 1 ml of peritoneal effusion collected from all patients and placed into heparinised tubes. Other biomarkers were measured in this study they were not directly relevant to the PICO question and will not be commented on further in this Knowledge Summary. Peritoneal fluid glucose concentration was significantly lower (P = 0.008) in dogs with septic effusion than those with nonseptic effusion. The median BFG difference was significantly higher in dogs with septic effusion than those with nonseptic effusion (P = 0.0005). A BFG difference >20 mg/dL (>1.1 mmol/L) was 100% sensitive and specific for diagnosis of SP in dogs, with PPV and NPV of 100%
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