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
The number and type of study designs reviewed
Three papers were critically reviewed, all of which were diagnostic test evaluation studies
Strength of evidence
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
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.
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Bonczynski, J. J., Ludwig, L. L., Barton, L. J., Loar, A. & Peterson, M. E. (2003). Comparison of Peritoneal Fluid and Peripheral Blood pH, Bicarbonate, Glucose, and Lactate Concentration as a Diagnostic Tool for Septic Peritonitis in Dogs and Cats. Veterinary Surgery. 32(2), 161–166. DOI: https://doi.org/10.1053/jvet.2003.50005
Guieu, L-V. S., Bersenas, A. M., Brisson, B. A., Holowaychuk, M. K., Ammersbach, M. A., Beaufrère, H., Fujita, H. & Weese, J. S. (2016). Evaluation of peripheral blood and abdominal fluid variables as predictors of intestinal surgical site failure in dogs with septic peritonitis following celiotomy and the placement of closed-suction abdominal drains. Journal of the American Veterinary Medical Association. 249(5), 515–525. DOI: https://doi.org/10.2460/javma.249.5.515
Koenig, A. & Verlander, L. L. (2015). Usefulness of whole blood, plasma, peritoneal fluid, and peritoneal fluid supernatant glucose concentrations obtained by a veterinary point-of-care glucometer to identify septic peritonitis in dogs with peritoneal effusion. Journal of the American Veterinary Medical Association. 247(9), 1027–1032. DOI: https://doi.org/10.2460/javma.247.9.1027
Lanz, O. I., Ellison, G. W., Bellah, J. R., Weichman, G. & VanGilder, J. (2001). Surgical treatment of septic peritonitis without abdominal drainage in 28 dogs. Journal of the American Animal Hospital Association. 37(1), 87–92. DOI: https://doi.org/10.5326/15473317-37-1-87
Martiny, P. & Goggs, R. (2019). Biomarker Guided Diagnosis of Septic Peritonitis in Dogs. Frontiers in Veterinary Science. 6, 208. DOI: https://doi.org/10.3389/fvets.2019.00208
Mueller, M. G., Ludwig, L. L. & Barton, L. J. (2001). Use of closed-suction drains to treat generalized peritonitis in dogs and cats: 40 cases (1997–1999). Journal of the American Veterinary Medical Association. 219 (6), 789–794. DOI: https://doi.org/10.2460/javma.2001.219.789
Szabo, S. D., Jermyn, K., Neel, J. & Mathews, K. G. (2011). Evaluation of Postceliotomy Peritoneal Drain Fluid Volume, Cytology, and Blood-to-Peritoneal Fluid Lactate and Glucose Differences in Normal Dogs. Veterinary Surgery. 40(4), 444–449. DOI: https://doi.org/10.1111/j.1532-950X.2011.00799.x
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