Castellote José, López Carmen, Gornals Joan, Tremosa Gemma, Fariña Eva Rodríguez, Baliellas Carmen, Domingo Alicia, Xiol Xavier
Servicio de Aparato Digestivo y Servicio de Hematología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Hepatology. 2003 Apr;37(4):893-6. doi: 10.1053/jhep.2003.50120.
We studied the use of reagent strips for diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites. A reagent strip for leukocyte esterase designed for the testing of urine with a colorimetric 5-grade scale (0 to 4) was used to evaluate ascitic fluid in 228 nonselected paracentesis performed in 128 cirrhotic patients. We diagnosed 52 SBP and 5 secondary bacterial peritonitis by means of polymorphonuclear cell count and classical criteria. When we considered positive a reagent strip result of 3 or 4, sensitivity was 89% (51 of 57), specificity was 99% (170 of 171), and positive predictive value was 98%. When we considered positive a reagent strip result of 2 or more, sensitivity was 96% (55 of 57), specificity was 89% (152 of 171), and negative predictive value was 99%. In conclusion, the use of reagent strips is a rapid, easy to use, and inexpensive tool for diagnosis of ascitic fluid infection. A positive result should be an indication for empirical antibiotic therapy, and a negative result may be useful as a screening test to exclude SBP.
我们研究了试剂条在肝硬化腹水患者自发性细菌性腹膜炎(SBP)诊断中的应用。一种用于尿液检测的比色法5级刻度(0至4)白细胞酯酶试剂条,被用于评估128例肝硬化患者进行的228次非选择性腹腔穿刺抽取的腹水。我们通过多形核细胞计数和经典标准诊断出52例SBP和5例继发性细菌性腹膜炎。当我们将试剂条结果3或4视为阳性时,敏感性为89%(57例中的51例),特异性为99%(171例中的170例),阳性预测值为98%。当我们将试剂条结果2或更高视为阳性时,敏感性为96%(57例中的55例),特异性为89%(171例中的152例),阴性预测值为99%。总之,试剂条的使用是一种快速、易用且廉价的腹水感染诊断工具。阳性结果应作为经验性抗生素治疗的指征,阴性结果可作为排除SBP的筛查试验。