Abstract
This prospective cross sectional study was carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Dhaka Shishu Hospital, Dhaka for a period of one year and six months starting from July 2012 to December 2013. The main objective of the study was to determine the serum ascitic fluid albumin concentration gradient in children with chronic liver disease and nephrotic syndrome. A total of 55 children were studied. Among them, 31 children with chronic liver disease with ascites were designated as Group I and rest 24 nephrotic syndrome children with ascites were designated as group II. The mean age of the children was 8.3±3.6 years ranging from 1.0-15.0 years. The mean age of the male patient was 8.0±3.6 years and that of female patients was 9.3±3.5 years. No statistically significant mean age difference was found between male and female patients (p>0.05), although female patients had a bit higher mean age than male patients. The mean age of the group I patients was 9.2±3.7 years ranging from 1.0-14.0 years and group II patients was 7.2±3.2 ranging from 2.0 to 15.0 years and the mean age difference between two groups patients was statistically significant (p 1.2 mg/dl, serum ALT >40 IU/L was 25 (80.6%), prothrombin time more than 3 second than control 23 (74.2%) and serum albumin less than 3.5 mg/dl was 24 (77.4%). The mean serum albumin was 2.8±0.5 mg/dl in group I patients and 1.7±0.4 mg/dl in group II patients. The albumin in ascitic fluid was 1.2±0.4 mg/dl in group I patients and 0.9±0.3 mg/dl in group II patients. Similarly, serum-ascites albumin gradient was 1.6±0.5 in group I and 0.8±0.2 in group II. It was evident that mean serum albumin, ascetic albumin as well as serum-ascites albumin gradient was significantly higher among the group I patients compared to group II patients (p<0.001).
Highlights
Chronic liver disease is not uncommon among pediatric population in Bangladesh [1] found that 4% of hospital admission into pediatric gastroenterology and general pediatric in patient department of a tertiary hospital were due to liver disease and of these 40% were chronic liver disease
The serum ascitic fluid albumin gradient (SAAG) the difference between serum albumin and ascitic fluid albumin, has been proved in multiple studies to categorize ascitis better than the total ascitic fluid protein concentration. [5, 6, 7, 8] It has been observed in the literatures devoted to internal medicine that serum ascitic fluid albumin concentration gradient (SAAG) correlates directly with portal pressure. [5, 8] SAAG is calculated by subtracting ascitic fluid albumin concentration from serum albumin concentration
31 children with chronic liver disease with ascites were designated as Group I and rest 24 nephrotic syndrome children with ascites were designated as group II
Summary
[5, 6, 7, 8] It has been observed in the literatures devoted to internal medicine that serum ascitic fluid albumin concentration gradient (SAAG) correlates directly with portal pressure. [10, 11] The present study was undertaken to see the SAAG as a predictor of portal hypertension in chronic liver disease in paediatric population. It is the major cause of death in portal hypertension. Serum ascitic fluid albumin gradient is cheap and simple test It can be done even in the different district levels in our country. We can use serum ascitic fluid albumin gradient as a screening test for portal hypertension in ascitic patients
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