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Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis

Authors

  • Jean-Baptiste Nousbaum,

    Corresponding author
    1. Services d'Hépato-Gastroentérologie de, Brest, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
    • Service d'Hépato-Gastroentérologie, CHU La Cavale Blanche, 29609 Brest Cedex, France
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    • fax: (33)-2-98-05-342597

    • The first two authors contributed equally.

  • Jean-François Cadranel,

    1. Services d'Hépato-Gastroentérologie de, Creil, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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    • The first two authors contributed equally.

  • Pierre Nahon,

    1. Services d'Hépato-Gastroentérologie de, Bondy, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Eric Nguyen Khac,

    1. Services d'Hépato-Gastroentérologie de, Amiens, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Richard Moreau,

    1. Services d'Hépato-Gastroentérologie de, Clichy, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
    2. Services d'Hépato-Gastroentérologie de, INSERM, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Thierry Thévenot,

    1. Services d'Hépato-Gastroentérologie de, Cambrai, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Christine Silvain,

    1. Services d'Hépato-Gastroentérologie de, Poitiers, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Christophe Bureau,

    1. Services d'Hépato-Gastroentérologie de, Toulouse Purpan, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Olivier Nouel,

    1. Services d'Hépato-Gastroentérologie de, Saint-Brieuc, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Christophe Pilette,

    1. Services d'Hépato-Gastroentérologie de, Le Mans, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Thierry Paupard,

    1. Services d'Hépato-Gastroentérologie de, Dunkerque, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Geoffroy Vanbiervliet,

    1. Services d'Hépato-Gastroentérologie de, Nice, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Frédéric Oberti,

    1. Services d'Hépato-Gastroentérologie de, Angers, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Thierry Davion,

    1. Services d'Hépato-Gastroentérologie de, Lens, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Vincent Jouannaud,

    1. Services d'Hépato-Gastroentérologie de, Creil, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Bruno Roche,

    1. Services d'Hépato-Gastroentérologie de, Villejuif, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Pierre-Henri Bernard,

    1. Services d'Hépato-Gastroentérologie de, Bordeaux Saint-André, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Sandrine Beaulieu,

    1. Services d'Hépato-Gastroentérologie de, Poissy, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Odile Danne,

    1. Services d'Hépato-Gastroentérologie de, Pontoise, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Dominique Thabut,

    1. Services d'Hépato-Gastroentérologie de, Paris Pitié-Salpétrière, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Carinne Chagneau-Derrode,

    1. Services d'Hépato-Gastroentérologie de, Poitiers, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Victor de Lédinghen,

    1. Services d'Hépato-Gastroentérologie de, Bordeaux Pessac, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Philippe Mathurin,

    1. Services d'Hépato-Gastroentérologie de, Lille, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Arnaud Pauwels,

    1. Services d'Hépato-Gastroentérologie de, Gonesse, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Jean-Pierre Bronowicki,

    1. Services d'Hépato-Gastroentérologie de, Nancy, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • François Habersetzer,

    1. Services d'Hépato-Gastroentérologie de, Strasbourg, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Armand Abergel,

    1. Services d'Hépato-Gastroentérologie de, Clermont-Ferrand, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Jean-Christian Audigier,

    1. Services d'Hépato-Gastroentérologie de, Saint-Etienne, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Thierry Sapey,

    1. Services d'Hépato-Gastroentérologie de, Châteauroux, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Jean-Didier Grangé,

    1. Services d'Hépato-Gastroentérologie de, Paris Tenon, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Albert Tran

    1. Services d'Hépato-Gastroentérologie de, Nice, U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, Hôpital Beaujon, Clichy, France
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  • Potential conflict of interest: Nothing to report.

Abstract

Recent studies have shown that the diagnosis of spontaneous bacterial peritonitis (SBP) can be rapidly obtained using leukocyte esterase reagent strips. However, published studies were restricted to one or two centers, and the number of patients with SBP was thus limited. The aims of the current prospective multicenter study were: (1) to assess the diagnostic accuracy of the Multistix 8SG urine test for the diagnosis of SBP; and (2) to assess the prevalence of SBP. From January to May 2004, 2 reactive strips were tested independently in inpatients with cirrhosis and in outpatients undergoing paracentesis. Cultures of ascitic fluid were performed at the bedside using aerobic and anaerobic blood culture bottles. Two thousand one hundred twenty-three paracenteses were performed in 1,041 patients from 70 centers. One hundred seventeen samples, obtained from 91 patients, had ascites polymorphonuclear cell (PMN) counts ≥250/μl (range, 250–34,000), among which 56 were associated with positive ascitic fluid cultures. The prevalence of SBP was 5.5% in the whole population, 9% in inpatients, and 1.3% in outpatients (P < 0.0001). The prevalence of SBP was 0.57% in asymptomatic outpatients versus 2.4% in symptomatic outpatients (P = 0.04). Using a threshold of 2+ for positivity of the reagent strip, sensitivity was 45.3% for the diagnosis of SBP, specificity was 99.2%, positive predictive value was 77.9%, and negative predictive value was 96.9%. Conclusion: This study confirms the low prevalence of SBP in asymptomatic outpatients according to a priori defined criteria, and indicates an absence of diagnostic efficacy for this specific strip test. (HEPATOLOGY 2007;45:1275–1281.)

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