Non-invasive diagnosis of peritoneal tuberculosis (preliminary results)

Background and Study Aims: Peritoneal biopsy remains the best diagnostic method for peritoneal tuberculosis in developing countries including Morocco, with significant morbidity and mortality. Hence the need to establish a non invasive diagnostic score of peritoneal tuberculosis from biochemical parameters measured in the ascites fluids. Patients and Methods: Prospective mono-centric study over a period of 4 years, including patients with isolated ascites, and those with peritoneal carcinomatosis. We tested the diagnostic value of each of the following biochemical parameters: glucose, total proteins, the Serum-Ascites serum albumin differential, LDH, total cholesterol, triglycerides, lymphocytes and Ca125 assayed in the ascites fluid; Correlate the results of these biochemical assays with those of laparoscopy to establish a non-invasive diagnostic score for peritoneal tuberculosis. For qualitative variables we calculated their sensitivity and specificity in the diagnosis of peritoneal tuberculosis compared to the reference examination. For the quantitative variables we determined the optimal threshold value for the establishment of the diagnosis of peritoneal tuberculosis by the use of the ROC curves. Results: 60 patients were included. The mean age was 44.5 years (16-83 years), Sex-ratio F / H 4.45. Univariate analysis of qualitative and quantitative variables revealed that disturbed VS, albuminemia <32.65g / l, ascites albumin> 22.05 g / l, ascites cholesterol> 0.69g / l, LDH> 249U / l, protidemia <69.5 g / l, Lymphocyte ascites> 375,5e / mm3 Leukocytes ascites> 545 e / mm3 represent the most discriminant variables in diagnosing peritoneal tuberculosis, with sensitivities and specificities> 75%. Multivariate analysis showed that the more parameters associated increases more we gain in specificity and positive predictive value (PPV) and one loses sensitivity and negative predictive value (NPV). Conclusion: The results are promising because the study was limited to 8 parameters whose diagnostic validity is satisfactory and on the basis of which the study can be continued.