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July 16, 2008

Polymorphonuclear Leukocyte Count in Spontaneous Bacterial Peritonitis—Reply

JAMA. 2008;300(3):282-283. doi:10.1001/jama.2008.29

In Reply: For reasons similar to those outlined by Dr De Gottardi, we chose to resolve the clinical scenario with the diagnostic test that had a high positive likelihood ratio and is recommended by current guidelines,1 the PMN count. Our article focused on the diagnostic accuracy of white blood cell count, PMN count, pH, and pH gradient. Although several studies have examined the accuracy of reagent strips to detect PMN count in ascitic fluid, they lacked standardization—different manufacturers, different numbers of grading scales, and different cut-offs for each grade.2,3 The assessment of reagent strips and several other less commonly reported tests of ascites such as lactate, lactate dehydrogenase, and glucose that have been studied in SBP4-6 were beyond the focus of our review. We agree with De Gottardi that reagent strips may be an economical, timely, and feasible tool for the clinician that should be subject to systematic review of the literature to determine their accuracy.