Umme Aeman Khan, Hamna Iqbal, Muhammad Omer Aslam, Muhammad Ehtisham Saqib, Hafiz M Yassen, Hafiz Amjad Hussain.
Spontaneous Bacterial Peritonitis; Evaluation of role of Ascitic Fluid Lactate Dehydrogenase in Diagnosis.
Professional Med J Jan ;25(4):589-93.

Objectives: To find out the diagnostic accuracy of ascitic fluid Lactate Dehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design: Cross sectional (validation) study. Setting: This study was conducted in department of Medicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting after approval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluid was withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cell count, total protein, albumin and LDH wascalculated along with serum albumin and serum LDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer, serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin from serum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratio was calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derived from total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years, 53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standard was recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenase in diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%, 88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negative likelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluid Lactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard.

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