6%) of patients were male (Table 1). Thirty specimens from 250 samples (12%) were diagnosed as SBP by manual cell count. Of these 30 samples, using 1+ cut off scale, SBP diagnosis was made by the Aution sticks test, Multistix10SG test, Combur 10 test in 27 (90%), 24 (80%), and 27 specimens (90%), respectively. Twenty-eight (93%) specimens were diagnosed as SBP by automated cell count (Table 2). The sensitivity, specificity, PPV, NPV, and accuracy of reagent strips and automated cell count to diagnose SBP are shown in Table 3. Automated system provided the highest value for SBP diagnosis in all parameters (sensitivity, specificity, PPV, NPV, and accuracy; 87.5–99.1%).
ABT 888 Multistix provided the lowest sensitivity (80%). The overall false negative rates by Aution stick, Multistix 10 SG, Combur 10 and automated cell count were 10%, 20%, 10% and 3.3%, respectively. Ten specimens had positive culture for bacteria, of which one was compatible with bacterascites. The results from the 3 strips in this bacterascites specimen were negative. No secondary bacterial peritonitis was diagnosed in this study. End stage liver disease patients presenting with SBP have significant rates of mortality and morbidity especially when the treatment is delayed.17 Hence, rapid diagnosis and prompt treatment are the goal to improve patients’ survival.
The standard investigation practiced worldwide is abdominal paracentesis and the decision to give antibiotics depends mainly on the result of PMN count, which is mostly done manually and requires significant waiting period. Speed, accuracy, and quality control are the main concern see more when the stat dose of antibiotic18 is required at bedside after paracentesis. Too often, the manual cell count may not be the first priority of the laboratory technician’s list.19 In addition, this is labor-intensive which makes it bottom in priority. Often, the result comes so late in the day and the clinician may not be aware of the result especially when the paracentesis is performed as routine large volume drainage in selleckchem non-SBP suspect. Similar to urine testing,
ascitic fluid analysis for PMN can be done at bedside with reagent strip and the result can be interpreted within minutes. Over decade, many studies reported on the excellent validity scores of these strips (Nephur, Multistix, Aution, Combur).8–13 However, the interest of diagnostic value of the strip test has dropped recently due to its suboptimal sensitivity especially in asymptomatic patient.14 We speculate that some certain strip has a lower sensitivity than others and may not be optimum for SBP diagnosis. To date, only a handful number of reports on direct comparison of some reagent strips are available.9,19–21 At the same level of cut off colorimetric scale ≥ 1, Sapey et al. reported that Nephur strip gave higher sensitivity than Multistix strip (88% vs 65%).9 Campillo et al.