RESUMEN
OBJECTIVES: We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm3. Ascites not related to portal hypertension were excluded. RESULTS: Overall, 649 patients from 21 French centers were included and 1,402 AF (803 AF samples from 315 outpatients and 599 samples from 334 inpatients) were assessed. Eighty-four AF samples (17 AF in 9 outpatients and 67 AF in 31 inpatients) were diagnosed as SBP. The prevalence of SBP was 6% (2.1% in outpatients vs. 11.2% in inpatients; P<0.001) and 7.2% in patients with symptoms suggestive of SBP (3% in outpatients vs. 11.3% in inpatients; P<0.001). The κ value for inter-reader agreement was 0.81 (95% confidence interval: 0.77-0.84) when using the "trace" threshold. Considering discordant results (n=131) as positive to interpret the diagnostic performance of the strip at the "trace" threshold, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.7, 57.1, 12.0, and 99.1%, respectively. At this "trace" threshold, sensitivity and NPV were both 100% in outpatients, and 89.5 and 97.9% in inpatients, respectively. At the "small" threshold, sensitivity, specificity, PPV and NPV were 81.0, 85.9, 25.9 and 98.7%, respectively. CONCLUSIONS: The Periscreen strip is a rapid and highly efficient tool for excluding SBP in the outpatient setting.
Asunto(s)
Ascitis/etiología , Líquido Ascítico/citología , Infecciones Bacterianas/diagnóstico , Leucocitos Mononucleares/citología , Cirrosis Hepática/complicaciones , Peritonitis/diagnóstico , Anciano , Atención Ambulatoria , Infecciones Bacterianas/etiología , Colorimetría , Femenino , Humanos , Recuento de Leucocitos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neutrófilos/citología , Paracentesis , Peritonitis/etiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Hepatic artery aneurysms (HAAs) are rare, accounting for approximately 14%-20% of visceral artery aneurysms. Most HAAs do not display any symptoms, but they may potentially lead to complications, as in the case of our patient who presented with an HAA compressing the common bile duct, detected through contrast-enhanced endoscopy. There are no specific treatment recommendations for HAAs due to their rarity. However, it is advisable to treat HAAs, even if they are asymptomatic, due to the risk of complications through surgical or radiological means. Our patient was treated with radiological embolization along with endoscopic biliary calibration.