Editorial
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 21, 2009; 15(31): 3845-3850
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3845
Ascitic fluid analysis for diagnosis and monitoring of spontaneous bacterial peritonitis
Oliviero Riggio, Stefania Angeloni
Oliviero Riggio, Stefania Angeloni, Department of Clinical Medicine, “Sapienza” University of Rome, Viale dell’Università 37, 00185 Roma, Italy
Author contributions: Angeloni S and Riggio O collected and revised the literature on the argument and wrote the paper.
Correspondence to: Oliviero Riggio, Professor, Department of Clinical Medicine, “Sapienza” University of Rome, Viale dell’Università 37, 00185 Roma, Italy. oliviero.riggio@uniroma1.it
Telephone: +39-6-49972001
Fax: +39-6-4453319
Received: May 31, 2009
Revised: July 15, 2009
Accepted: July 22, 2009
Published online: August 21, 2009
Abstract

Polymorphonuclear (PMN) cell count in the ascitic fluid is essential for the diagnosis and management of spontaneous bacterial peritonitis (SBP). To date, PMN cell count is routinely performed by traditional manual counting. However, this method is time-consuming, costly, and not always timely available. Therefore, considerable efforts have been made in recent years to develop an alternative test for a more rapid diagnosis and monitoring of SBP. The use of urinary reagent strips was proposed to achieve an “instant” bedside diagnosis of SBP. A series of reports evaluated the urine strip test for SBP diagnosis and reported promising results. However, a recent large multicenter study revealed a surprising lack of diagnostic efficacy of the urine screening test for SBP diagnosis. Another method, more recently proposed as an alternative to the manual PMN count, is the measurement of lactoferrin in ascitic fluid, but the data available on the diagnostic value of this test are limited to a single study. However, both urinary reagent strips and ascitic lactoferrin tests are qualitative methods and need, therefore, to be further confirmed by standard cytology of the ascitic fluid. To date, the only quantitative method proposed as a valid alternative to manual PMN counting is automated blood cell counters, commonly used in all laboratories for blood cell counting. Data available in the literature on the diagnostic performance of this method are limited but very promising, and this tool seems to have the potential to replace the manual counting method.

Keywords: Ascites; Ascitic fluid lactoferrin; Automated blood cell counter; Paracentesis; Polymorphonuclear cell count; Urinary reagent strips