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Abstract
Background:
Cirrhosis frequently progresses to ascites, and spontaneous bacterial peritonitis (SBP) remains a life-threatening complication associated with significant mortality, particularly when diagnosis is delayed. Although ascitic fluid polymorphonuclear (PMN) count ≥250 cells/mm³ is the diagnostic gold standard, laboratory dependence may hinder timely management in resource-limited settings. This study evaluates the diagnostic accuracy of leukocyte esterase dipstick testing as a rapid bedside tool for early detection of SBP in cirrhotic patients with ascites.
Materials and Methods:
This cross-sectional diagnostic accuracy study was conducted at Federal Government Polyclinic Hospital, Islamabad, enrolling 250 consecutive adult cirrhotic patients with ascites undergoing diagnostic paracentesis. Leukocyte esterase dipstick testing was performed bedside and compared with the reference standard of ascitic fluid PMN count ≥250 cells/mm³. Diagnostic performance parameters including sensitivity, specificity, predictive values, and overall accuracy were calculated using SPSS, with p <0.05 considered statistically significant.
Results:
A total of 250 cirrhotic patients with ascites were analyzed, of whom 75 (30.0%) were diagnosed with spontaneous bacterial peritonitis based on ascitic PMN count ≥250 cells/mm³. Patients with SBP more frequently presented with fever, abdominal pain, hepatic encephalopathy, higher serum bilirubin levels, and low ascitic protein (all p <0.05), while age and gender distribution were comparable between groups. Using a dipstick threshold of ≥1+, leukocyte esterase testing demonstrated a sensitivity of 84.0%, specificity of 89.7%, positive predictive value of 77.8%, negative predictive value of 92.9%, and overall diagnostic accuracy of 88.0% for SBP detection.
Conclusion:
Leukocyte esterase dipstick testing shows high diagnostic accuracy as a rapid, bedside screening tool for spontaneous bacterial peritonitis in cirrhotic patients with ascites. Its low cost and immediate availability make it a practical adjunct in resource-limited settings to support early clinical decisions and prompt antibiotic initiation.