Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2024; 16(11): 1265-1281
Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1265
Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method
Juan G Acevedo-Haro, Waddah Mohamed, Prebashan Moodley, Oliver Bendall, Kris Bennett, Nigel Keelty, Sally Chan, Sam Waddy, Joanne Hosking, Wayne Thomas, Robert Tilley
Juan G Acevedo-Haro, Waddah Mohamed, Prebashan Moodley, Oliver Bendall, Kris Bennett, Nigel Keelty, Sally Chan, South West Liver Unit, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, United Kingdom
Juan G Acevedo-Haro, Peninsula Medical School, University of Plymouth, Plymouth PL6 8DH, United Kingdom
Sam Waddy, Intensive Care Unit, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, United Kingdom
Joanne Hosking, Medical Statistics Group, Peninsula Clinical Trials Unit, University of Plymouth, Plymouth PL6 8DH, United Kingdom
Wayne Thomas, Haematology Service, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, United Kingdom
Robert Tilley, Microbiology Service, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, United Kingdom
Author contributions: Acevedo-Haro JG, Tilley R, Hosking J, and Thomas W designed the study; Mohamed W, Moodley P, Bendall O, Bennett K, Keelty N, Chan S, and Acevedo-Haro JG participated in data collection; Acevedo-Haro JG, Hosking J, and Tilley R participated in data analysis and interpretation; Acevedo-Haro JG, Tilley R, Thomas W, and Waddy S participated in the writing group.
Institutional review board statement: During the registration process, the proposal was scrutinized from an ethics and data protection perspective and concluded that the project: Was not sharing or receiving identifiable data outside of our organization.
Informed consent statement: Patients were not required to give informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Not applicable.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Juan G Acevedo-Haro, PhD, Doctor, South West Liver Unit, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth PL6 8DH, United Kingdom. jacevedo@nhs.net
Received: June 19, 2024
Revised: September 9, 2024
Accepted: September 25, 2024
Published online: November 27, 2024
Processing time: 139 Days and 18.4 Hours
Core Tip

Core Tip: The traditional cutoff recommended by international guidelines (250 polymorphs × 106/L in ascitic fluid) to diagnose spontaneous bacterial peritonitis (SBP) was set when automated cell counters were not available. There are no data comparing the manual and the automated cell count in patients with cirrhosis against gold standard SBP cases and employing the cell analyzers currently available. This study compares both cells count methods against SBP cases fulfilling gold standard criteria and shows that the automated method has better sensitivity: 80% vs 52%, P = 0.02 and has a good specificity (96%). It also shows that the most accurate cutoff to diagnose SBP is 0.2 polymorphs × 109/L. Guidelines should recommend the use of one of the modern automated cell counters instead of the manual method.