Diagnostic Accuracy of Leucocyte Esterase Dipstick Test for The Diagnosis of Spontaneous Bacterial Peritonitis in Children with Nephrotic Syndrome

Abstract

Spontaneous bacterial peritonitis (SBP), which has a high fatality rate if antibiotics are not given promptly, is one of the most serious side effects of nephrotic syndrome and ascites. Therefore, it is essential for survival to diagnose and treat SBP early. A quick dipstick test for leukocyte esterase can identify the SBP. Objective: To determine the diagnostic accuracy in detection of SBP using leucocyte esterase dipstick test in children with nephrotic syndrome taking ascitic fluid neutrophil count as gold standard. Methods: A Cross Sectional Study was carried out Khyber teaching hospital and LRH Peshawar Pakistan. This research covered patients of either gender with nephrotic syndrome and ascites. On admission, diagnostic paracentesis was performed. The ascitic fluid collected at the bedside was examined immediately using a reagent strip. The PMN cell count in ascitic fluid was then determined. A positive +3 result on a leukocyte esterase dipstick was declared positive for SBP while absolute neutrophil count more than 250 cells per mm3 was considered confirmatory. Results: A total of 107 patients were enrolled. Age of the patients ranged from 4 to 14 years. Mean age of the patients was 6.68 ± 1.239 years. Male to female ratio was 1.7: 1. The sensitivity, specificity, positive and negative predictive value of leucocyte esterase dipstick test were 86.4%, 92.0%, 73.1% and 96.4% respectively. Conclusion: It is concluded that reagent strips are quick, practical, and low-cost diagnostics with good sensitivity and specificity for identifying SBP in children with nephrotic syndrome