LEUKOCYTE ESTERASE TEST IN DIAGNOSING SPONTANEOUS BACTERIAL PERITONITIS IN CIRRHOTIC PATIENTS

Spontaneous bacterial peritonitis (SBP) requires rapid diagnosis and initiation of antibiotics. Diagnosis of SBP is usually based on cytobacteriological examination of ascitic fluid. The aim of this work was to evaluate the diagnostic utility of reagent strip (Combostick 10 SG) for rapid diagnosis of SBP. Methods: This cross-sectional, case finding, hospital-based study was carried out on 81 patients aged ≥ 18 years old, both sexes, diagnosed with cirrhosis and ascites. Bedside leukocyte esterase reagent strip testing was performed on ascitic fluid. Cell count as determined by colorimetric scale of reagent strip was compared with automated complete blood count and chamber method. Results: There was a significant difference between patients having symptom suggestive of SBP and the percentage of SBP on standard laboratory tests and nitrate reagent test in those testing positive for SBP by standard lab in 81 patients with cirrhosis and ascites, while there was insignificant different between etiology of cirrhosis and percentage of SBP. Leukocyte estrase strips and its sensitivity and specificity test when considering (+++), (++) and < (+) as positive in those tested positive for SBP were significantly different between both groups (P<0.05).  The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of reagent strip (+) positive were 95%, 100%, 100%, 98.4% respectively compared to automated cell counting and counting chamber method. Conclusions: Reagent strip to diagnose SBP is very sensitive and specific as compared to automated cell counting and counting chamber method.