Abstract

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is one of the potentially life-threatening complications in ascetic cirrhotic patients. The improved survival might be explained by a more rapid and accurate diagnosis and treatment. Our aim is to evaluate the combined use of a leucocyte esterase strip together with ascetic fluid lactoferrin antibodies for rapid and accurate diagnosis of spontaneous bacterial peritonitis when compared with standard manual laboratory polymorphonuclear leucocyte counting. METHODS: Non-selected cirrhotic 84 patients undergoing diagnostic paracentesis had an ascitic sample sent for a conventional polymorphonuclear leucocyte count. In addition, a sample was tested with a bedside leucocyte esterase reagent strips, and another sample was tested by Human Lactoferrin, LTF/LF kits detected by Enzyme linked immunosorbent assay (ELISA). RESULTS: Sensitivity of both leucocyte esterase reagent test & lactoferrin antibody test was 0.71 with confidence interval (0.53-0.85). Specificity of both leucocyte esterase reagent test & lactoferrin antibody test was 1.00 with confidence interval (0.93-1.00). Positive predictive value of both leucocyte esterase reagent test & lactoferrin antibody test was 1.00 with confidence interval (0.86-1.00). Negative predictive value of both leucocyte esterase reagent test & lactoferrin antibody test was 0.83 with confidence interval (0.71-0.92). Diagnostic accuracy of combined leucocyte esterase reagent test & lactoferrin antibody test was 0.88 with confidence interval (0.79-0.94). CONCLUTION: Combined use of both leucocyte esterase reagent strips and lactoferrin antibody showed high values of specificity, positive predictive value, negative predictive value and accuracy for leucocyte esterase ≥ +2 and lactoferrin antibody ≥ 83 ng/ml. However, sensitivity decreased.