Clinicopathological correlation of serum ascites albumin gradient with ascitic fluid total protein in patients of ascites with portal hypertension attending a tertiary care hospital in Eastern Bihar, India
DOI:
https://doi.org/10.18203/2349-3933.ijam20172282Keywords:
AFTP, Non-portal hypertension related ascites, Portal hypertension related ascites, SAAGAbstract
Background: The level of ascitic fluid total protein (AFTP) is used to differentiate between transudative and exudative ascites. Ascites patients having portal hypertension are considered to be transudative in nature. The traditional transudate/exudate system of ascitic fluid classification based on ascitic fluid total protein concentration is sometimes misleading in patients of ascites with portal hypertension. Now a days SAAG (serum ascites albumin gradient) has become more acceptable in differentiating patients presenting with ascites due to portal hypertension. The objective of this prospective study was to correlate serum ascites albumin gradient with ascitic fluid total protein in patients of ascites having portal hypertension.
Methods: 100 cases of ascites are selected randomly. All the provisional diagnosis are confirmed with the help of different biochemical, pathological and radiological investigations.
Results: SAAG (≥1.1gm/dl) was more sensitive and specific (94% and 90% respectively) than ascitic fluid total protein concentration of <2.5 gm/dl (78% and 50% respectively) in detecting portal hypertension and had higher positive and negative predicative values (97% and 82% respectively) compared to AFTP concentration (85% and 38% respectively).
Conclusions: Considering the advantages of measuring the serum-ascites albumin gradient in illuminating the pathogenesis of ascites and the ease with which this test can be done, it is suggested that this parameter should replace the traditional parameter of ascitic fluid total protein level in the routine analysis of ascites fluid and classification of ascites.
References
Ascites and spontaneous bacterial peritonitis. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th edition. 2015;93:1553.
Cirrhosis and its Complications. In: Harrison’s Principles of Internal Medicine 19th edition. 2015;365:2060.
Ascites and spontaneous bacterial peritonitis. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th edition. 2015;93:1560.
Laudanno OM, Bresciani P, Silva M. Diagnostic efficacy of albumin gradient in different cases of ascites. Acta Gastroenterol Latinoon. 1995;25(5):285-90.
Alba D, Torres E, Vazquez JJ. Sero-ascitic gradient of albumin:usefulness and diagnostic limitations. An Med Intern. 1995:12(8):404-7.
Runyon BA, Montano AA, Akriviads EA, Antillon MR, Irving MA, Hutchison JG. Comparison of the utility of serum ascites albumin gradient to the exudate/transudate concept in the differential diagnosis of ascites. Hepatol. 1992:62.
Pare P. Talbot J, Hoefs JC. Serum ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites. Gastroenterol. 1983;85:240-4.
Marshal JB, Vogele KA. Serum-ascites albumin difference in tuberculous peritonitis. Am J Gastroenterol. 1988;83(11):1259-61.
Cabrol JE, Lettao MC, Guerra C, Tome I, Pinto ML, Casta D, et al. Value of ascitic lipids and sero-ascitic gradient of albumin in the different diagnosis of albumin. Acta Med Port. 1989;2(1):17-20.
Goyal AK, Goyal SK, Pokharna DS, Sharma SK. Differential diagnosis of ascitic fluid :evaluation and comparison of various biochemical criteria with a special reference to serum ascites albumin concentration gradient and its relation to portal pressure. Trop Gastroenterol. 1989;10(1):51-5.
Kajani MA, Yoo YK, Alexander IA, Gavaler, Stauber RE, Dindzans VJ, et al. Serum-Ascites albumin gradient in nonalcoholic liver disease. Dig Dis Sci. 1990;35(1):33-7.
