Patel Kishan P, Gallagher John P, Korbitz Parker M, Schmidt Cynthia, Ingviya Thammasin, Sempokuya Tomoki, Manatsathit Wuttiporn
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):519-532. doi: 10.1016/j.jceh.2021.05.002. Epub 2021 May 12.
Spontaneous bacterial peritonitis (SBP) is a bacterial infection associated with a high mortality rate in cirrhotic patients. The gold standard for the detection of SBP is a manual cell count from ascitic fluid; however, alternative screening methods are under investigation. In particular, leukocyte esterase reagent strips (LERS) has been studied as an alternative method to detect SBP with a low cost and instant turnaround time. Therefore, this study aims to evaluate the performance of LERS in the detection of SBP.
A literature search was performed for studies evaluating LERS for the detection of SBP on PubMed, Embase, Scopus, Cochrane, and clinical trial registries. Summary sensitivity, specificity, log diagnostic odds ratio (LDOR), and the area under the summary receiver operating curve (AUC) were calculated according to the respective manufacturer.
In total, 31 studies were evaluated. The summary sensitivity of Aution Sticks, Combur, Multistix, Periscreen reagent strips was 0.962 (95% confidence interval [CI] 0.926, 0.998), 0.892 (95% CI 0.846, 0.938), 0.806 (95% CI 0.738, 0.874), and 0.939 (95% CI 0.900, 0.979), respectively. The summary specificity of Aution Sticks, Combur, Multistix, and Periscreen reagent strips was 0.940 (95% CI 0.904, 0.976), 0.922 (95% CI 0.874, 0.970), 0.974 (95% CI 0.962, 0.985), and 0.672 (95% CI 0.381, 0.963), respectively.
LERS appears to have a notable overall performance for the detection of SBP. LERS appeared to be an acceptable alternative to diagnose SBP in facilities without ability to perform cell count. However, there were significant differences in performance between each manufacturer.
自发性细菌性腹膜炎（SBP）是一种与肝硬化患者高死亡率相关的细菌感染。检测SBP的金标准是对腹水进行手工细胞计数；然而，替代筛查方法正在研究中。特别是，白细胞酯酶试剂条（LERS）已作为一种低成本、快速出结果的检测SBP的替代方法进行了研究。因此，本研究旨在评估LERS在检测SBP方面的性能。
在PubMed、Embase、Scopus、Cochrane和临床试验注册库中检索评估LERS检测SBP的研究。根据各自制造商的数据计算汇总敏感性、特异性、对数诊断比值比（LDOR）和汇总接受者操作特征曲线下面积（AUC）。
共评估了31项研究。奥通试纸、Combur试纸、尿十项试纸、Periscreen试剂条的汇总敏感性分别为0.962（95%置信区间[CI]0.926，0.998）、0.892（95%CI0.846，0.938）、0.806（95%CI0.738，0.874）和0.939（95%CI0.900，0.979）。奥通试纸、Combur试纸、尿十项试纸和Periscreen试剂条的汇总特异性分别为0.940（95%CI0.904，0.976）、0.922（95%CI0.874，0.970）、0.974（95%CI0.962，0.985）和0.672（95%CI0.381，0.963）。
LERS在检测SBP方面似乎具有显著的总体性能。在没有进行细胞计数能力的机构中，LERS似乎是诊断SBP的一种可接受的替代方法。然而，各制造商之间在性能上存在显著差异。
