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; John P Gallagher; Parker M Korbitz; Cynthia Schmidt; Thammasin Ingviya; Tomoki Sempokuya; Wuttiporn Manatsathit

doi:10.1016/j.jceh.2021.05.002

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

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

Authors

Kishan P Patel¹, John P Gallagher¹, Parker M Korbitz², Cynthia Schmidt³, Thammasin Ingviya^{4

5}, Tomoki Sempokuya⁶, Wuttiporn Manatsathit⁶

Affiliations

¹ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
² Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
³ McGoogan Library of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
⁴ Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
⁵ Medical Data Center for Research and Innovations, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.

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.