The Diagnostic Value of Leukocyte Esterase Reagent Dip-stick in Spontaneous Bacterial Peritonitis Diagnosis in Patients with Liver Cirrhosis

Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a serious complication of advanced liver cirrhosis which requires rapid diagnosis for the initiation of proper antibiotic therapy. Manual examination of ascetic fluid is a rather time-consuming procedure. The leukocyte esterase (LE) reagent dipstick is based on the esterase activity of activated granulocytes which reacts with an ester‑releasing hydroxyphenylpyrrole causing a color change in the azo dye of reagent strip. Aim: the aim of this study was to evaluate the diagnostic value of leukocyte esterase reagent dipstick in SBP diagnosis in patients with liver cirrhosis attending Suez Canal University Hospital. Methods: ascetic fluid cell count using the counting chamber method was compared to Leucocyte Esterase strip rapid test in two groups of patients (65 ABP vs 65 non-SBP). The strips were read in 120 seconds using colorimetric 5-grade scale (from 0 to 4). The grades (0-2) were considered a negative test while grades (3-4) were considered a positive one. Results: Comparison of the SBP +ve and -ve groups showed a sensitivity of LE strips of (82%) with a high specificity (94 %), PPV (93 %) and NPV (84 %) for the diagnosis of SBP. A good correlation between the LE strip color grade and the ascetic fluid PMNL cell count number (P<0.05) Conclusion: the leukocyte esterase reagent dipstick test is a rather specific, rapid, inexpensive and simple bedside method for diagnosis of SBP method for. A negative LE test result excludes SBP with a high accuracy.