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269 LEUKOCYTE ESTERASE DIPSTICK TESTING AS A RAPID TEST FOR DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS SC Grover, P Wong BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a cause of significant morbidity and mortality in the decompensated cirrhotic. Antibiotics are administered in those individuals who are culture positive or who have an ascitic polymorphonuclear (PMN) cell count of > 250 cells per microlitre. Obtaining these results in a timely fashion is sometimes not always possible, resulting in empiric antibiotic therapy. The leukocyte esterase test is a rapid dipstick test commonly used for urine to screen for the presence of infection.
Division of Gastroenterology, University Health Network, Toronto, Ontario
METHODS: 39 paracenteses were performed on 23 cirrhotic patients with ascites. The most common causes of cirrhosis were chronic hepatitis C (9), non-alcoholic fatty liver disease (3), alcohol (3), autoimmune hepatitis (2) and primary sclerosing cholangitis (2). The average patient age was 54 years. Fluid samples were dipped using the Multistix 10SG strip and were assessed for fluid cell count, differential, and culture. SBP was defined as a PMN count of greater than 250 cells per microlitre. A positive leukocyte esterase test was considered to be a value above "trace".
RESULTS: 5 diagnoses of SBP were made on cell count and 2 were culture positive. Two samples were excluded due to clotting. The sensitivity and specificity of leukocyte esterase testing were 60% and 95% respectively. The positive and negative predictive values were 60% and 95% respectively. Two false positive results were associated with visible red staining of ascitic fluid and a red blood cell count of greater than 20,000 cells per millilitre.
CONCLUSIONS: Dipstick leukocyte esterase testing is an inexpensive, rapid and specific screening test for bedside diagnosis of spontaneous bacterial peritonitis that is easy to use and widely available. Its high negative predictive value may prevent unnecessary antibiotic use and hospitalizations in patients with ascites. These preliminary results will be validated with continued enrollment in this pilot study.