Valeur diagnostique de la lymphocytose du liquide d’ascite et du gradient albumine sérum ascite dans la tuberculose péritonéale en milieu africain

Abstract

Background and aimsTuberculous peritonitis (TP) is endemic in developing countries and tubercular ascites is commonly lymphocytic. The presence of ascitic lymphocytosis (AL) as an indicator of TP is not well established however and has not been compared with using the serum-ascites albumin gradient (SAAG) in black Africans with TP.Patients and methodsSeventy-five consecutive patients with ascites (median age: 41 years) were included. Of these, 43 (53.3%) had TP (group 1) and 32 (42.7%) had cirrhosis or hepatocellular carcinoma (group 2). The following parameters were studied: age, sex, SAAG and ascitic fluid cytology. Sensitivity, specificity and diagnostic performance were determined by AUROC analysis for AL and by calculation for SAAG. Diagnostic efficiency was calculated for AL and SAAG using previously published formulae.Resultspatients in group 1 were younger (P = 0.006) and mostly female (P = 0.04). Median value of SAAG (g/l) was low in group 1 compared to group 2 (8.7 vs 10; P = 0.005) and the median value of AL (cells/mm3) was high in group 1 compared to group 2 (1058.4 vs 326.5; P = 0.001). Diagnostic agreement between SAAG and AL was poor (kappa = 0.4 ± 0.1). Diagnostic accuracy of AL was average (AUROC = 0.74 ± 0.1). Sensitivity, specificity and diagnostic efficiency were 76, 68 and 70% respectively for AL (cut-off value 508 cells/mm3) and 96, 42 and 60% for SAAG (cut-off value 11 g/l).ConclusionOur study demonstrated that diagnostic accuracy of AL was modest with respect to diagnosing TP amongst black Africans with lymphocytic ascites. It should be used in association with SAAG, whose sensitivity is greater, for diagnosis of TP in patients with AL in African countries with poor medical facilities.