What is the role of ascitic fluid studies in the workup of spontaneous bacterial peritonitis (SBP)?

Updated: Mar 23, 2021
  • Author: Thomas E Green, DO, MPH, CPE, MMM, FACEP, FACOEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Other studies of ascitic fluid to be considered include the following:

  • Cytology

  • Lactate level

  • pH

An ascites lactate level of more than 25 mg/dL was found to be 100% sensitive and specific in predicting active spontaneous bacterial peritonitis in a retrospective analysis. In the same study, the combination of an ascites fluid pH below 7.35 and polymorphonuclear neutrophil count above 500 cells/µL was 100% sensitive and 96% specific for spontaneous bacterial peritonitis.

A 2012 study investigated using leukocyte reagent strips in the emergency department as a means of expediting the diagnosis of spontaneous bacterial peritonitis. [23] In this prospective study, 223 patients presenting with ascites and who had paracentesis performed in the emergency department had their peritoneal fluid sent for the usual diagnostic tests, but they also had the fluid dipped with both a Uri-Quick Clini 10 strip and Multistix 10SGA. Both had at least 90% positive predictive value and 94% negative predictive value for spontaneous bacterial peritonitis when compared with the criterion standard of peritoneal fluid Gram stain and culture—thus allowing a shorter interval between diagnosis and initiation of treatment.

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