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(Chest. 2000;118:1450-1454.)
© 2000 American College of Chest Physicians

Correlation of Leukocyte Esterase Detection by Reagent Strips and the Presence of Neutrophils*

A Study in BAL Fluid

Jan A. Jacobs, MD, PhD; Els I. G. B. De Brauwer, MD; Elisa I. M. Cornelissen, MT and Marjolein Drent, MD, PhD

* From the Departments of Medical Microbiology (Drs. Jacobs, De Brauwer, and Ms. Cornelissen) and Pulmonology (Dr. Drent), University Hospital Maastricht, Maastricht, The Netherlands.

Correspondence to: Jan A. Jacobs, MD, PhD, Department of Medical Microbiology, University Hospital of Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands; e-mail: JJA{at}ms-azm-3.azm.nl

Study objective: In the present study, we evaluated the leukocyte esterase (LE) area of a reagent strip designed for urinalysis for the semiquantitative measurement of the percentage of polymorphonuclear neutrophils (PMNs) in BAL fluid.

Design: Prospective. The relative PMN counts (obtained by conventional microscopy and expressed as a percentage of a 500 cell count) of consecutive BAL fluid samples were compared with the corresponding LE categories as read with a urine chemistry reader. LE categories were graded as follows: negative, trace, +, + +, and + + +.

Results: A total of 153 BAL fluid samples were included. The mean PMN counts of the negative LE category (4.1 ± 4.3%; n = 43) and the + + + category (81.8 ± 16.3%; n = 37) differed significantly from each other and from the mean PMN counts of the other categories. Within the trace, +, and + + categories, a considerable overlap of PMN counts was noted. Assignment of a BAL fluid to the negative LE category consistently predicted a PMN count < 20%. At a threshold value of 50% PMNs, the + + + LE category predicted the BAL fluid samples to the correct group (PMNs > 50% vs < 50%) with a sensitivity of 70.8% and a specificity of 97.1%.

Conclusions: The reagent strips proved to be useful as a rapid test for semiquantitative measurement of the relative PMN counts in BAL fluid. However, the low predictive value for the exclusion of a high PMN count may limit their application.

Key Words: BAL • leukocyte esterase • polymorphonuclear neutrophils • reagent strips • ventilator-associated pneumonia






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