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. 2022 Mar-Apr;12(2):519-532.
doi: 10.1016/j.jceh.2021.05.002. Epub 2021 May 12.

Performance of Leukocyte Esterase Reagent Strips in the Detection of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Systematic Review and Meta-analysis

Kishan P Patel  1 , John P Gallagher  1 , Parker M Korbitz  2 , Cynthia Schmidt  3 , Thammasin Ingviya  4   5 , Tomoki Sempokuya  6 , Wuttiporn Manatsathit  6
Affiliations

Performance of Leukocyte Esterase Reagent Strips in the Detection of Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Systematic Review and Meta-analysis

Kishan P Patel et al. J Clin Exp Hepatol. 2022 Mar-Apr.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: AUC, area under the summary receiver operating curve; LDOR, log diagnostic odds ratio; LERS, leukocyte esterase reagent strips; PMN, polymorphonuclear; SBP, Spontaneous bacterial peritonitis; SROC, summary receiver operating characteristic; ascites; cirrhosis; leukocyte esterase; reagent strips; spontaneous bacterial peritonitis.

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Figures

Figure 1
Figure 1
A flowchart demonstrating the study search and selection process for this meta-analysis according to the PRISMA statement. (∗Four studies evaluated two LERS, whereas one study evaluated 3 LERS for the detection of SBP).
Figure 2
Figure 2
Forest plots demonstrating individual and summary sensitivity and specificity of each study evaluating Aution Sticks for the detection of SBP: sensitivity of Aution sticks (A) and specificity of Aution Sticks (B).
Figure 3
Figure 3
Forest plots demonstrating individual and summary sensitivity and specificity of each study evaluating Combur for the detection of SBP: sensitivity of Combur (A) and specificity of Combur (B).
Figure 4
Figure 4
Forest plots demonstrating individual and summary sensitivity and specificity of each study evaluating Multistix for the detection of SBP: sensitivity of Multistix (A) and specificity of Multistix (B).
Figure 5
Figure 5
Forest plots demonstrating individual and summary sensitivity and specificity of each study evaluating Periscreen for the detection of SBP: sensitivity of Periscreen (A) and specificity of Periscreen (B).
Figure 6
Figure 6
Deeks' funnel plots of studies evaluating Aution Sticks (A), Combur (B), Multistix (C), and Periscreen (D). ESS, effective sample size.
Supplementary Figure 1
Supplementary Figure 1
Summary receiver operating characteristic (SROC) curves of studies evaluating Aution Sticks for the detection of SBP.
Supplementary Figure 2
Supplementary Figure 2
Summary receiver operating characteristic (SROC) curves of studies evaluating Combur for the detection of SBP.
Supplementary Figure 3
Supplementary Figure 3
Summary receiver operating characteristic (SROC) curves of studies evaluating Multistix for the detection of SBP.
Supplementary Figure 4
Supplementary Figure 4
Summary receiver operating characteristic (SROC) curves of studies evaluating Periscreen for the detection of SBP.
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References

    1. Setoyama H., Tanaka M., Sasaki Y. Springer Singapore; Singapore: 2019. Diagnosis of Spontaneous Bacterial Peritonitis in Clinical Investigation of Portal Hypertension; pp. 511–516.
    1. Gad A., El-Nemr N., Saad M. The diagnostic value of leukocyte esterase reagent dip-stick in spontaneous bacterial peritonitis diagnosis in patients with liver cirrhosis. Suez Canal Univ Med J. 2019;22:56–63.
    1. Shizuma T. Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: a literature review. World J Hepatol. 2018;10:254–266. - PMC - PubMed
    1. Kim H., Shim J.H., An J., et al. Reappraisal of the accuracy of diagnostic criteria for spontaneous bacterial peritonitis in cirrhotic patients with or without hepatocellular carcinoma: a preliminary result. Gut. 2018;67:A1–A118.
    1. Fiore M., Maraolo A.E., Leone S., et al. Spontaneous peritonitis in critically ill cirrhotic patients: a diagnostic algorithm for clinicians and future perspectives. Therapeut Clin Risk Manag. 2017;13:1409–1414. - PMC - PubMed