Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhosis with high morbidity and mortality. Early diagnosis and treatment improve survival. Diagnosis is made by ascitic fluid Polymorphoneuclear leukocytes (PMNL) count of >250/mm3 which takes hours and may not be available in rural settings. Leukocyte esterase reagent strips (LERS) test have shown high sensitivity, specificity, and negative predictive value in the diagnosis of SBP. This study was conducted to find the utility of the LERS test for the diagnosis of SBP. This was a prospective hospital-based study conducted at the National Academy of Medical Sciences, Bir Hospital, Nepal. LERS test was performed on ascitic fluid from 140 cirrhotic patients. Colorimetric grading was compared with PMNL count for diagnosing SBP. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for diagnosing SBP calculated for grade 3 and grade 4 as cut-offs. Among 140 patients, SBP was diagnosed in 27. Grade 3 as cut-off, sensitivity, specificity, PPV, and NPV for the LERS test were 96.3, 90.2, 70.3, and 99 percent respectively. For grade 4 as cut-off, sensitivity, specificity, PPV, and NPV were 81.5, 99.1, 95.6, and 95.7 percent respectively. Accuracy were 91.4 and 95.2 percent for grade 3 and 4 as cut-off respectively. LERS test has shown high sensitivity, specificity, and negative predictive value for the diagnosis of SBP in cirrhotic ascitis. Being simple, rapid, and cost-effective, it can be useful at bedside to start early antibiotic therapy before availability of the PMNL count report.
BACKGROUND Gastrointestinal symptoms and Liver injury have been frequently described in patients with COVID-19.In this study, we aim to study the prevalence of Gastrointestinal symptoms and Liver injury and their impact on disease severity and clinical outcomes. METHODS This is a descriptive, cross sectional observational study done in 195 patients admitted to Bir Hospital with Corona virus Disease-19(COVID-19) from May 2021 to July 2021.Patients presenting symptoms and liver function tests (LFTs) were noted at admission. Gastrointestinal symptoms were defined as the presence of one of Nausea, Vomiting, Abdominal pain or Diarrhea. Liver injury was defined as elevation of Total Bilirubin > 1mg/dl or Alanine transaminase (ALT) >40U/L, Aspartate Transaminase(AST) >40U/L or Alkaline Phosphatase(ALP)>135 U/L. Patients were followed during hospitalization and outcomes assessed at discharge. RESULTS Gastrointestinal symptoms were present in 32.3% among which Nausea (27.7%) was the commonest. There was no significant association of Gastrointestinal symptoms with duration of hospital stay, ICU admission or mortality. Liver injury was present in 72.8% patients and significantly more in those with GI symptoms than without GI symptoms. Patients with liver injury had a significantly longer hospital stay (8.92 ± 3.7 days vs 6.70±3.2 days, p=0.004), higher ICU admissions (38.02% vs 7.54% p=0.000018) and mortality (23.23% vs 1.88%, p=0.001) compared to patients with normal LFTs. CONCLUSION Gastrointestinal symptoms and Liver Injury are common in patients with COVID-19. Liver injury at admission is associated with severe disease and higher mortality. More attention should be given in the care of such patients to avoid poor outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.