Can measurement of glucose levels in blood and peritoneal fluid be used to diagnose septic peritonitis in dogs?

Abstract

PICO question Can the measurement of blood and peritoneal fluid effusion glucose levels be used to accurately diagnose septic peritonitis in dogs when compared to cytology and bacterial culture?   Clinical bottom line Category of research question Diagnosis The number and type of study designs reviewed Three papers were critically reviewed, all of which were diagnostic test evaluation studies Strength of evidence Moderate Outcomes reported Glucose measurements can be used to diagnose septic peritonitis when the blood plasma glucose level is >2.1 mmol/L higher than that of the peritoneal fluid glucose when using a veterinary point of care (POC) glucometer. If using a biochemistry analyser, a whole blood glucose >1.1 mmol/L higher than that of the peritoneal fluid can be used to diagnose septic peritonitis. This is only relevant when the peritoneal fluid is collected by abdominocentesis and not in a postoperative period Conclusion At present, there is moderate evidence that glucose measurements are useful as a patient side test for the diagnosis of septic peritonitis and are especially useful in cases where intracellular bacteria cannot be identified on cytology. However, despite the so far promising accuracy results, the cut-offs reported are quite variable and overall, there is not a single diagnostic test that is 100% sensitive and specific in repeated studies. Therefore, the results of the glucose measurements should be evaluated alongside other biomarker testing, imaging modalities and the clinical presentation of the patient. Glucose measurements cannot currently replace culture / sensitivity and cytology as the gold standard for the diagnosis of septic peritonitis   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.