Immediate diagnostic criteria for bacterial infection of ascitic fluid. Evaluation of ascitic fluid polymorphonuclear leukocyte count, pH, and lactate concentration, alone and in combination.
Immediate diagnostic criteria for bacterial infection of ascitic fluid. Evaluation of ascitic fluid polymorphonuclear leukocyte count, pH, and lactate concentration, alone and in combination.
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DOI：
10.1016/0016-5085(86)90392-6
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发表时间：
1986-05
期刊：
影响因子：
29.4
通讯作者：
W. Stassen;Arthur J. McCullough;Bruce R. Bacon;Steven H. Gutnik;Ismail M. Wadiwala;Christine E. McLaren;Satish C. Kalhan;Anthony S. Tavill
中科院分区：
文献类型：
--
作者：
W. Stassen;Arthur J. McCullough;Bruce R. Bacon;Steven H. Gutnik;Ismail M. Wadiwala;Christine E. McLaren;Satish C. Kalhan;Anthony S. Tavill
我们前瞻性地评估了 60 名患者的单份腹水中的腹水 (AF) 多形核细胞 (PMN) 计数、pH 值和乳酸浓度，以确定它们对立即诊断腹水感染的相对预测值。 60 份腹水中有 9 份是恶性的。其余51个样本中，有9个来自肝硬化患者被感染。感染组的平均 AF pH、乳酸浓度和 PMN 计数分别为 7.20 ± 0.19、80 ± 51 mg/dl 和 18,199 ± 19,650 个细胞/mm3，均与未感染腹水的相应值显着不同。感染组的平均动脉血-腹水（B-AF）pH值和乳酸梯度分别为0.23±0.17和-46±31mg/dl，与非感染腹水的相应值显着不同（p<0.05）。除 AF PMN 计数外，感染性腹水和恶性腹水之间未发现显着差异 (p < 0.001)。对于肝硬化腹水，AF pH ≤ 7.34 是最特异的单一测试 (100%)，并且具有最高的诊断准确性 (98%)。在患有不同病因的腹水的较大群体中，B-AF pH 梯度≥0.10 或 AF PMN 计数≥500 个细胞/mm3 是诊断准确性最高的单一测试（92%）。与最佳单一标准相比，将 AF PMN 计数 >500 个细胞/mm3 与任何其他诊断标准相结合可提高特异性和诊断准确性（高达 98%）。尽管我们的数据支持使用多种不同的 AF 测量组合来立即诊断感染，但最简单且最容易获得的测量结果是 pH 值和 PMN 计数。因此，在临床环境中，我们建议使用 AF pH ≤ 7.34 或 B-AF pH 梯度≥0.10 结合 AF PMN 计数 >500 个细胞/mm3，以获得腹水感染即时诊断的最高准确度。
We prospectively evaluated the ascitic fluid (AF) polymorphonuclear cell (PMN) count, pH, and lactate concentration in single ascitic fluids from 60 patients to determine their relative predictive values for the immediate diagnosis of ascitic fluid infection. Nine of the 60 ascitic fluids were malignant. Of the remaining 51 samples, nine from cirrhotic patients were infected. The mean AF pH, lactate concentration, and PMN count in the infected group were 7.20 ± 0.19, 80 ± 51 mg/dl, and 18,199 ± 19,650 cells/mm3, respectively, and all were significantly different from the corresponding values in noninfected ascites. Mean arterial blood-ascitic fluid (B-AF) pH and lactate gradients in the infected group were 0.23 ± 0.17 and −46 ± 31 mg/dl, respectively, and were significantly different from the corresponding values in noninfected ascites (p < 0.05). Significant differences were not found between infected and malignant ascites, except for the AF PMN count (p < 0.001). In cirrhosis with ascites, an AF pH ≤ 7.34 was the most specific single test (100%) and had the highest diagnostic accuracy (98%). In the larger group of patients with ascites of diverse etiology, a B-AF pH gradient ≥0.10 or an AF PMN count ≥500 cells/mm3were the single tests with the highest diagnostic accuracy (92%). Combining an AF PMN count >500 cells/mm3with any of the other diagnostic criteria increased the specificity and diagnostic accuracy (up to 98%) compared to the best single criterion. Although our data support the use of a number of different combinations of AF measurements for the immediate diagnosis of infection, the simplest and most readily obtainable measurements are the pH and PMN count. Therefore, in the clinical setting we recommend the use of either an AF pH ≤ 7.34 or a B-AF pH gradient ≥0.10 in combination with an AF PMN count >500 cells/mm3to obtain the highest degree of accuracy in the immediate diagnosis of ascitic fluid infection.