Decision tools for diagnosing spontaneous bacterial peritonitis: a systematic review and meta-analysis

Khazar  Garjani; Elnaz  Vahidi; Mehrad  Aghili; Amir Abbas  Azimi Nezhad; Parinaz  Dadlani; Hadi  Mirfazaelian

doi:10.18502/fem.v9i4.20868

Khazar Garjani Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Elnaz Vahidi Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Mehrad Aghili Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Amir Abbas Azimi Nezhad Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Parinaz Dadlani Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Hadi Mirfazaelian Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/fem.v9i4.20868

Keywords: Cirrhosis; Decision Tool; Diagnosis; Spontaneous Bacterial Peritonitis

Abstract

Backgound: Approximately one-third of the spontaneous bacterial peritonitis (SBP) are missed due to the absence of paracentesis, and any delay in antibiotic initiation significantly increases mortality. Clinical decision tools may help to rule out or rule in the diagnosis without paracentesis. This study systematically reviewed the performance of available decision tools for diagnosing SBP in adult patients with cirrhosis.

Methods: We included all original studies that evaluated clinical decision tools for SBP diagnosis. Search was conducted in MEDLINE, Embase, Scopus, and Web of Science Core Collection from inception to September 2024. Study quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS 2).

Results: From 2038 records, 44 articles were scrutinized in full text. Twenty-four studies ultimately met eligibility criteria. Most of the studies were at low risk of bias. Several tools relied on laboratory findings with clinical features. In meta-analysis the Mansoura scoring system (cut-off of 4) showed a pooled sensitivity of 70.96% (95% CI: 42.06%,99.86%) and a negative predictive value 92.27% (95% CI: 88.80%,95.74%). The Wehmeyer’s scoring system achieved pooled specificity and positive predictive value of 98.43% (95% CI: 95.29,101.58%) and 90.26% (95% CI: 70.28,110.23%). A MELD score >15 yielded had pooled sensitivity of 83.85% (95% CI: 78.50%,89.20%) and negative predictive value of 87.56% (95% CI: 81.29%,93.84%).

Conclusion: Several decision tools, particularly laboratory-based (e.g. procalcitonin) tools, showed high sensitivity to potentially rule out SBP. Some other tools (e.g. Mansoura, Wehmeyer rules) can reliably rule in the diagnosis. However, tools all the tools need further validation before widespread adoption.