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MedPulse - International Medical Journal, ISSN 2348-2516 E-ISSN: 2348-1897

Volume 1, Issue 8, June 2014 pp 381-384

Research Article

Efficacy of serum ascites albumin gradient and ascitic fluid protein in determining ascites etiology

S Suresh Saravanakumar¹, Buvana Balamugundan²

¹Associate Professor, Department of General Medicine, Aarupadai Veedu Medical College & Hospital, Puducherry -607402 INDIA.

²Assistant Professor, Sree Lakshmi Narayana Institute of Medical Sciences & Hospital, Osudu, Kudupakkam, Puducherry – 605502 INDIA.

Academic Editor : Dr. Bhanap P. L.

Introduction: The pathologic accumulation of fluid in the peritoneal cavity denotes the term ‘ascites’. The various causes of ascites may be classified into two broad patho-physiologic categories, first one is associated with a normal peritoneum and second one occurs in a diseased peritoneum. Earlier ascites was classified as transudative and exudative. But it was quite confusing as various diagnoses were overlapped in transudative and Exudative. to overcome these shortcomings ascites is being classified as "high gradient" and "low gradient" Aims and Objectives: To compare the diagnostic accuracy of serum ascites albumin gradient with the traditional marker ascitic fluid total protein. Material and Method: in the present study total 50 patients of ascites were enrolled. The serum ascites albumin gradient was calculated in all the patients after measuring the serum and ascitic fluid albumin concentrations and simply subtracting the ascitic fluid value from the serum value. To increase the accuracy of SAAG, specimens of serum and ascitic fluid were obtained simultaneously. Ascitic fluid total protein was also measured in all the cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SAAG and AFTP was also calculated and compared. Results: Cirrhosis of the liver (74%) was the most common cause of ascites in the study subjects. There were 8% cases of cirrhosis, 18% cases of TB ascites and 2% cases of peritoneal carcinomatosis had high SAAG ascites. 66% of Cirrhosis patients and one case of CCF, Nephrotic syndrome and Liver metastasis had low SAAG ascites. 60% of cases presented as exudative and 40% of cases had transudative ascites. SAAG (94%) was having more diagnostic accuracy as compared to AFTP (62%). Conclusion: Thus Serum ascites albumin gradient (SAAG) is the single best test against ascitic fluid total protein (AFTP), in the differential diagnosis of ascites.