Role of leukocyte estrase reagent strips and myeloperoxidase for diagnosing spontaneous bacterial peritonitis

Objectives The aim was to assess the role of leukocyte estrase reagent strips and myeloperoxidase (MPO) for diagnosing spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Background Liver cirrhosis represents one of the major causes of death worldwide. Cirrhotic patients with ascites show a higher susceptibility to bacterial infections with SBP that is the most frequent infectious complication. The gold standard for diagnosing SBP is a polymorphonuclear neutrophil count of 250 cells/μl in ascitic fluid. Urine reagent strips have been proposed as a rapid and inexpensive alternative. MPO has a preoxidant–proinflammatory property and its level increases in cases of infection. Patients and methods In total, 90 patients with decompensated chronic liver disease and ascites participated in this study, including (Group I) 20 patients having no symptoms and PMN count (<250 cells/mm3), (Group II) 35 patients with a picture of SBP and PMN count <250 cells/mm3, and (Group III) 35 symptomatic patients with PMN count >250 cells/mm3. Ascitic PMN count and MPO level were measured. Also, ascetic fluid samples were assessed by leukocyte esterase reagent strips (LERS). Results The mean value of MPO was statistically significantly higher in group III (1640.1 ± 480.6 ng/ml) than group II (595.4 ± 201.3 ng/ml) than group I (479.2 ± 236.2 ng/ml). The cutoff value of ascetic MPO was greater than 959.7 ng/ml with accuracy 100%. The mean value of LERS was significantly higher in group III (230 ± 210.8) than group I (14 ± 10.2) and group II (13 ± 9.9). The cutoff value of LERS was greater than 15 leukocytes/μl with accuracy 76%. Conclusion Rapid bedside diagnostic tests for SBP could be performed using MPO and LERS.