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World J Gastroenterol. Oct 7, 2008; 14(37): 5689-5694
Published online Oct 7, 2008. doi: 10.3748/wjg.14.5689
Accuracy of the automated cell counters for management of spontaneous bacterial peritonitis
Oliviero Riggio, Stefania Angeloni, Antonella Parente, Cinzia Leboffe, Giorgio Pinto, Teresa Aronne, Manuela Merli
Oliviero Riggio, Stefania Angeloni, Antonella Parente, Cinzia Leboffe, Giorgio Pinto, Teresa Aronne, Manuela Merli, Department of Clinical Medicine, “Sapienza” University of Rome, Rome 00185, Italy
Author contributions: Angeloni S, Leboffe C and Parente A enrolled the patients and collected and analysed the data; Pinto G and Aronne T performed the PMN cell count in the ascitic fluid by the manual method and the automatic cell counter, respectively; Merli M and Riggio O designed the study and wrote the paper.
Correspondence to: Oliviero Riggio, Professor, II Gastroenterologia, Dipartimento di Medicina Clinica, “Sapienza” Università di Roma, Viale dell’Università 37, Rome 00185, Italy. oliviero.riggio@uniroma1.it
Telephone: +39-6-49972001 Fax: +39-6-49972001
Received: March 28, 2008
Revised: September 16, 2008
Accepted: September 23, 2008
Published online: October 7, 2008
Abstract

AIM: To evaluate the accuracy of automated blood cell counters for ascitic polymorphonuclear (PMN) determination for: (1) diagnosis, (2) efficacy of the ongoing antibiotic therapy, and (3) resolution of spontaneous bacterial peritonitis (SBP).

METHODS: One hundred and twelve ascitic fluid samples were collected from 52 consecutive cirrhotic patients, 16 of them with SBP. The agreement between the manual and the automated method for PMN count was assessed. The sensitivity/specificity and the positive/negative predictive value of the automated blood cell counter were also calculated by considering the manual method as the “gold standard”.

RESULTS: The mean ± SD of the difference between manual and automated measurements was 7.8 ± 58 cells/mm3, while the limits of agreement were +124 cells/mm3 [95% confidence interval (CI): +145 to +103] and -108 cells/mm3 (95% CI: -87 to -129). The automated cell counter had a sensitivity of 100% and a specificity of 97.7% in diagnosing SBP, and a sensitivity of 91% and a specificity of 100% for the efficacy of the ongoing antibiotic therapy. The two methods showed a complete agreement for the resolution of infection.

CONCLUSION: Automated cell counters not only have a good diagnostic accuracy, but are also very effective in monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP.

Keywords: Spontaneous bacterial peritonitis, Ascites, Polymorphonuclear cell count, Automated cell counter, Paracentesis, Cirrhosis