ABSTRACT
Introduction: Spontaneous bacterial peritonitis (SBP) remains a major complication of decompensated chronic liver disease and contributes to 20% in-hospital mortality.1,5 Timely diagnosis is vital in the management of SBP, and overall improved outcomes1. A systematic review of 19 studies comparing the use of Reagent strips to cyto bacteriological analysis showed the high negative predictive value of leucocyte esterase dipsticks in the diagnosis of SBP 2. The COVID 19 pandemic has seen lab capacity including microbiology reprioritised. This called for adaptation in various areas of medicine to find innovative ways to aid ease pressure on services such as turnaround time of results. Aims & Methods: The aim was to assess the applicability of the leucocyte esterase reagent test kit (LERT) as a screening bedside test on ascitic fluid samples for the rapid diagnosis of SBP, during the peak of the COVID 19 Pandemic. Methodology: This prospective study included 3 district general hospitals in Kent and Sussex catchment areas of South East England. Data was collected between 1st May 2020 to 30th June 2020 during the first wave of the pandemic. Inclusion criteria: 1. Inpatients admitted with decompensated chronic liver disease with moderate or tense ascites. 2. Patients presenting to ambulatory care units for ascites management. 3. Inpatients with malignant ascites. Ascitic fluid samples used were the same samples obtained by the primary team at the patients initial encounter. Leucocyte esterase dipstick (Multistix SG) tests performed on the ascitic fluid samples were compared with the formal microbiology manual white cell count, neutrophil count and cultures results. To ensure validity of the results, two observes (doctor, nurse, health care assistant) were required to read the results from the leucocyte esterase test kit one minute after the test was completed. Results were recorded on an excel spreadsheet stored on hospital secure drive. Results: A total of 35 patients met inclusion criteria. Aetiology of ascites and number of patients : Alcohol Liver Disease (17) NASH Cirrhosis (3), Mixed Alcohol liver disease/ Haemochromatosis (3) , Alcoholic liver disease /Hepatitis C (1), Primary Sclerosing Cholangitis (1) , Malignancy (10). Mean age : 66.7 years. 66% were male patients and 34% female. This study demonstrated the that 2 plus leucocytes on the LERT correlated with a manual absolute neutrophil count of >250cells/mm3 and requirement of one minute to analyse the LERT to improve the diagnostic sensitivity. This was not mentioned in methodology from various studies reviewed in our literature search3,4. Conclusion: This multisite study, although a small sample size, is in accordance with similar studies showing the relatively high negative predictive value of the bedside LERT kit 3,4. This was particularly useful at a time of the COVID 19 pandemic peak when lab capacity had been redirected to cope with the increased volume of lab samples.