Runyon's criteria

Q: Which of the following is not part of Runyon's criteria to diagnose secondary bacterial peritonitis? (select one)

A) Total protein >1 g/dL

B) Glucose <50 mg/dL

C) LDH >the upper limit of normal for serum

D) Absolute neutrophil count (ANC) >10,000 per microliter

  

Answer: D

  

Proposed laboratory criteria for diagnosis of secondary bacterial peritonitis, also known as Runyon's criteria, include at least two of the following ascetic fluid:

• Total protein >1 g/dL (10 g/L)
• Glucose <50 mg/dL (2.8 mmol/L)
• LDH >the upper limit of normal for serum

Cultures showing a polymicrobial infection or a Gram stain demonstrating large numbers of different bacterial forms suggest gut perforation.

Although the specificity of the criteria is about 96%, sensitivity is only 67%.

  

Two other lab findings that may make the suspicion stronger but not part of the criteria are ascetic fluid carcinoembryonic antigen (CEA) level and alkaline phosphatase levels, which suggest gut perforation. 

  

  

#GI

#ID

  

  

References:

  

1. Akriviadis EA, Runyon BA. Utility of an algorithm in differentiating spontaneous from secondary bacterial peritonitis. Gastroenterology 1990; 98:127.

  

2. Soriano G, Castellote J, Alvarez C, et al. Secondary bacterial peritonitis in cirrhosis: a retrospective study of clinical and analytical characteristics, diagnosis and management. J Hepatol 2010; 52:39.

3. Runyon BA, Hoefs JC. Ascitic fluid analysis in the differentiation of spontaneous bacterial peritonitis from gastrointestinal tract perforation into ascitic fluid. Hepatology 1984; 4:447.

  

4. Wu SS, Lin OS, Chen YY, et al. Ascitic fluid carcinoembryonic antigen and alkaline phosphatase levels for the differentiation of primary from secondary bacterial peritonitis with intestinal perforation. J Hepatol 2001; 34:215.