• Brian Chinnock and Gregory W Hendey.
• Department of Emergency Medicine, UCSF-Fresno Medical Education Program, Community Regional Medical Center, Fresno, CA 93701, USA. b.chinnock@comcast.net
• Am J Emerg Med. 2007 Oct 1;25(8):934-7.

ObjectiveThe objective of the study was to determine the sensitivity and specificity of abnormal ascitic fluid appearance in the detection of spontaneous bacterial peritonitis (SBP), as a sensitivity approaching 100% could exclude SBP if the fluid is clear.MethodsWe performed a retrospective review of all ascitic fluid samples sent for cell count over a 4-year period. Spontaneous bacterial peritonitis was defined as an absolute neutrophil count of more than 250 cells/mm3 or a positive culture. Abnormal fluid appearance was defined as hazy, cloudy, or bloody.ResultsThere were 916 ascitic fluid samples analyzed during the study period. Eighteen percent of samples had a clear appearance, whereas 82% were abnormal. Abnormal ascitic fluid appearance had a sensitivity of 98.1% (95% confidence interval, 95.3%-99.5%) and a specificity of 22.7% (95% confidence interval, 19.4%-26.3%) in the detection of SBP.ConclusionsAbnormal fluid appearance has a high sensitivity for the detection of SBP. Thus, clear fluid might safely exclude SBP.

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