ROLE OF SERUM-ASCITES ALBUMIN GRADIENT IN DIFFERENTIAL DIAGNOSIS OF ASCITES
Abstract
Background: The classification of ascites as '˜exudative' and '˜transudative' based on ascitic fluidtotal protein (AFTP) has been challenged in many clinical conditions like cardiac ascites, patients
on prolonged diuretic therapy and malignant ascites because it had poor diagnostic efficacy. These
drawbacks have led to the development of another approach to classify ascites, which is based on
Serum-Ascites Albumin Gradient (SAAG) to differentiate ascitic fluid into two categories: SAAG
‰¥11 g/L in ascites due to portal hypertension and SAAG <11 g/L in ascites unrelated to portal
hypertension. Objective of this study was to compare the diagnostic efficacy of serum/ascites fluid
albumin gradient and ascitic fluid total protein in patients having ascites. Methods: This Crosssectional comparative study was conducted in the Department of Chemical Pathology and
Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from 1st Jun 2007 to 30th May
2008. Ninety-three patients were included in the study by non probability convenience sampling.
The patient grouped as: (Group I) 73 cases of liver cirrhosis, (Group II) 14 cases of hepatoma and
6 cases of tuberculous ascites. Ascitic fluid specimen and 3 ml blood were obtained for ascitic
fluid estimation of ascitic fluid albumin, total proteins and serum albumin. Diagnostic efficacy of
SAAG and AFTP was calculated by comparing the results with clinical, ultrasonographic, histopathological findings, ascitic fluid cell count/acid fast bacilli culture and other relevant
investigations. Results: Seventy-three cases had liver cirrhosis (group I), 14 cases had hepatoma
and 6 cases had tubercular ascites (group II). Age ranged 25-80 years with mean age 56 years.
Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value (PPV) and Negative
predictive value (NPV) of SAAG were 96%, 97%, 95%, 98.6%, and 90% respectively, whereas
those of AFTP were 56%, 53%,70%, 86%, and 29% respectively. Conclusion: Differential
diagnosis of ascites should be based on SAAG because diagnostic efficacy of SAAG was
significantly higher than AFTP in work-up of ascites.
Keywords: Ascites, Serum/ascites albumin gradient, Ascitic fluid total protein
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