Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

Mukhyaprana Prabhu,Rahul Sai Gangula,Weena Stanley

doi:10.1155/2019/8546010

Mukhyaprana Prabhu, Rahul Sai Gangula + Show 1 more

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https://doi.org/10.1155/2019/8546010

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Abstract

Context Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. Aims To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites. Settings and Design The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis. Statistical Analysis Used ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).

Highlights

Ascites is the pathological accumulation of fluid in peritoneal cavity [1, 2]
None of the gradients had any statistical difference between malignancy and tubercular peritonitis groups (Table 2)
There was no difference observed between malignancy and tubercular peritonitis groups for the same variables

Summary

Introduction

Ascites is the pathological accumulation of fluid in peritoneal cavity [1, 2]. Most common causes of ascites are parenchymal liver disease followed by peritoneal malignancy, tubercular peritonitis, congestive cardiac failure, nephrotic syndrome, and others (hypoalbuminemia, chylous ascites, Budd-Chiari syndrome, mixed ascites, and malnutrition) [1, 2]. Treatment of ascites depends on the aetiology of ascites, for which numerical diagnostic parameters were investigated [3, 4]. No single parameter has completely demarcated among them; the quest for better investigation continues [3, 4]. According to the traditional way of classification, aetiology of ascites were differentiated based on transudate and exudate concept with levels of Total Protein (> 2.5 gm/dL) in ascitic fluid [5,6,7]. SAAG criteria had completely replaced the traditional way of classification [7]. According to SAAG criteria, the Serum Ascites Albumin Gradient ≥ 1.1 gm/dL is usually associated with increased portal pressure [7]. The ability of SAAG to differentiate malignant ascites from other etiologies is a major problem [7]

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