The diagnostic utility of serum ascites albumin gradient against ascitic fluid total protein for detection of liver disease in patients of ascites- A comparative study
Abstract
Introduction: Various studies have demonstrated superiority of SAAG (serum ascites albumin gradient) in classifying ascites compared to transudate-exudate concept but with conflicting observations. Ascitic fluid total protein (AFTP) level in ascitic fluid is a much cheaper alternative to the serum ascites albumin gradient ratio. Hence in the study, we have compared the diagnostic accuracy of the old cheaper traditional method against the new method.
Methods: Total 102 patients of Ascites were included in the study from J.A. group of hospital, G.R. Medical College (M.P.) in year 2013-15. All medical causes of ascites were included in our study and Non medical causes were excluded. The collected data was analyzed by using Pearson Chi-square statistical analysis to determine correlation between variables.
Result: For prediction of liver disease it was found that SAAG was significantly (p value 0.0341) more predictive of Liver disease compared to AFTP. SAAG (p value<0.0009) and AFTP (p value 0.49) were both significant for differentiating cause of ascites when comparison was done between liver and non-liver disease.
Conclusion: AFTP is a good surrogate marker for detection of liver disease in ascites. AFTP is an excellent diagnostic test for detection of certain extra hepatic diseases leading to ascites like tubercular peritonitis sub-acute bacterial peritonitis and anaemia-hypo-proteinemia.
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References
2. Sampliner RE, Iber FL. High protein ascites in patients with uncomplicated hepatic cirrhosis. Am J Med Sci. 1974 May;267(5):275-9. [PubMed]
3.RectorWG Jr, Reynolds TB. Superiority of the serum ascites albumin difference over the ascites total protein concentration in separation of "transudative" and "exudative" ascites. Am J Med. 1984 Jul;77(1):83-5. [PubMed]
4. Rector WG Jr. An improved diagnostic approach to ascites. Arch Intern Med. 1987 Feb;147(2):215. [PubMed]
5. Paré P, Talbot J, Hoefs JC. Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites.Gastroenterology. 1983 Aug;85(2):240-4.
6. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis ofascites. Ann Intern Med. 1992 Aug 1;117(3):215-20.
7. 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. Tropical Gastroenterology 1989 Jan-Mar; 10 (1): 51-5.
8. Gupta R, Misra SP, Dwivedi M et al. Diagnostic ascites :Value of total protein albumin, cholesterol their ratios serum ascites albumin and cholesterol gradient. J Gastroenterology Hepatology 1995 May-Jun; 10 (3): 295-9. [PubMed]
9. Kajani MA, Yoo YK, Alexander JA, Gavaler JS, Stauber RE, Dindzans VJ, Van Thiel DH. Serum ascites albumin gradients in nonalcoholic liver disease. Dig Dis Sci. 1990 Jan;35(1):33-7. [PubMed]
10. Starling EH. On the Absorption of Fluids from the Connective Tissue Spaces. J Physiol. 1896 May 5;19(4):312-26. [PubMed]
11. Das B, Acharya U, Purohit A. Comparative utility of sero ascites albumin gradient and ascitic fluid total protein for differential diagnosis of ascites. Indian Pediatr. 1998 Jun;35(6):542-5. [PubMed]
12. Al-Knawy BA. Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease. Ann Saudi Med. 1997 Jan;17(1):26-8. [PubMed]
13.Younas M, Sattar A, Hashim R, Ijaz A, Dilawar M, Manzoor SM, Ali A, Khan FA. Role of serum-ascites albumin gradient in differential diagnosis of ascites. J Ayub Med Coll Abbottabad. 2012 Jul-Dec;24(3-4):97-9.
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