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

Abstract

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.