Page 240 LEUKOCYTE ESTERASE IN ASCITES FLUID FOR DETECTING SPONTANEOUS BACTERIAL PERITONITIS IN LIVER CIRRHOSIS 1 Department of Clinical Pathology, Faculty of Medicine, University of North Sumatra/Adam Malik Hospital, Medan, Indonesia. E-mail: dr.mawarafrida@gamil.com 2 Department of Internal Medicine Gastro-Hepatology Division, Faculty of Medicine, University of North Sumatra/ Adam Malik Hospital, Medan, Indonesia ABSTRACT Spontaneous Bacterial Peritonitis (SBP) is a frequent complication in liver cirrhosis with ascites patients. Spontaneous bacterial peritonitis is often without symptoms, so diagnosis is often delayed. Ascites fluid analysis is expensive, while the ascites fluid culture, as the gold standard, takes a long time and is expensive too. Besides, not all hospitals have the facilities to do both tests. Dye strip test that detect leukocyte esterase, that was originally developed to detect the presence of polymorphonuclear cells in the urine was also sensitive and accurate for detecting the presence of polymorphonuclear cells in the ascites fluid. This examination is easy and quick to do and very cheap so that can be used for early detection of SBP. To determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of dye strip leukocyte esterase test for early detection of SBP in liver cirrhosis with ascites patients were studied. This study used a dye strip leukocyte esterase (Combur 10 Test®M) in 28 samples of ascites fluid and compared with the results of ascites fluid culture. The ability of the leukocyte esterase test as a diagnostic test was very good at a cut-off +2 with 94.1% specificyity, 63.6% sensitivity 32% PPV and 80% NPV. Examination leukocyte esterase in the ascites fluid could be used for early detection of SBP in liver cirrhosis with ascites patients and could help to exclude SBP................ ..................................................................................................... Key words: Leukocyte esterase, early detection, liver cirrhosis, spontaneous bacterial peritonitis INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Majalah Patologi Klinik Indonesia dan Laboratorium Medik 2018 July 24(3): 240-243 p-ISSN 0854-4263 | e-ISSN 2477-4685 Available at www.indonesianjournalofclinicalpathology.org INTRODUCTION Liver cirrhosis is the end stage of various liver diseases characterized by fibrosis. 1,6 Ascites is a pathological fluid accumulation in the peritoneal cavity as a frequent complication of liver cirrhosis. Approximately 10%-30% of cases of liver cirrhosis with ascites may progress to Spontaneous Bacterial Peritonitis (SBP). 2,3 Spontaneous bacterial peritonitis is defined as a spontaneous infection of ascites fluid in the absence of an apparent source of intra-abdominal infection or inflammation. Spontaneous bacterial peritonitis is a common complication in patients with liver cirrhosis due to late diagnosis. Portal hypertension causes a bacterial translocation in the intestine that cannot be eliminated due to immune system disorders in liver cirrhosis. Abdominal pain and fever are the most common symptoms of SBP, followed by vomiting, ileus, diarrhea, hepatic encephalopathy, gastrointestinal bleeding, and kidney failure. However, most patients with spontaneous bacterial peritonitis have no symptomatic clinical manifestation. Therefore, establishing the diagnosis of SBP is not sufficient only by exploring clinical symptoms but also by investigating ascites fluid analysis. Polymorphonuclear cell (PMN) counting (≥ 250 cells/ mm 3 ) and positive culture of ascites fluid are the gold standards to diagnose SBP, but both take a long time and are expensive. Also, not all hospitals have facilities to perform these examinations. Therefore, a rapid, easy and inexpensive examination is needed as a diagnostic test of SBP. 2,4 Leukocyte esterase dye test initially developed to detect the presence of polymorphonuclear cells in the urine was also sensitive and accurate to detect the presence of polymorphonuclear cells in other body fluids such as pleural fluid, cerebrospinal fluid, peritoneal fluid and seminal fluid. Many studies in developing countries, including India, showed an accelerated diagnosis process of SBP from a few hours to a few minutes. 2-4 The reagent strip detects leukocyte esterase found in granulocytes, monocytes, and macrophages. The principle of the dye test is based on the activity of leukocyte esterase which breaks the ester present in the reagent strip. The colorless indoxyl ester degradation by granulocytes becomes unstable and is easily oxidized to a violet color. 5,6 The high number of deaths caused by SBP up to 80% has prompted the researchers to examine whether the leukocyte esterase test could be used as an accurate diagnostic test and rapidly diagnose SBP in the Adam Malik Hospital Medan and other healthcare centers in areas with limited facilities. Mawar Afrida 1 , Ricke Loesnihari 2 , Juwita Sembiring 2