Abstract
Purpose: To show the interest of the serum-ascites concentration gradient in albumin (SAAG) in the etiological diagnosis of ascites in African black. Materiel and Methods: This was a monocentric observational and analytical study performed on patients over 15 years old and hospitalized in the Hepato-Gastroenterology department of Cocody from January 1st, 2010 to March 31st, 2017 for ascites. The cytology and chemistry of the ascites fluid and the protidogram were performed. The main outcome measure was the prediction of portal hypertension (PHT) or non-portal hypertension related causes of ascites from SAAG. Results: The hospital prevalence of ascites was 11%. There were 82 women (46.9%) and 93 men (53.1%) with a sex ratio (M/F) of 1.1. SAAG was low in 68.6% of cases and high in 31.4% of cases. The most common etiologies were post-viral cirrhosis (74%), HCC (16.60%) and peritoneal tuberculosis (13.7%) respectively. In the case of high SAAG, 91% of ascites related to PHT were observed, but also 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%. All patients with peritoneal tuberculosis had a SAAG low of less than 1.1 g/dl significantly (p = 0.002). SAAG had a diagnostic performance of 89% in peritoneal tuberculosis at the cutoff value of ?1.24 g/dl (AUROC = 0.91, Se = 96%, Sp = 86%) while in post viral hepatitis cirrhosis at a threshold of 0.58 g/dl the diagnostic performance was 60% (AUROC = 0.69, Se = 53%, Sp = 79%). Conclusion: The simple technical SAAG, allowing to distinguish the ascites linked to the PHT and the ascites not bound to the PHT, can be used like a method of diagnosis of the etiologies of the ascites especially in the peritoneal tuberculosis in the African countries low income.
Highlights
The causes of ascites are multiple, two etiologies predominate, liver cirrhosis for transudative ascites and peritoneal tuberculosis for exudative ascites in our contexts
serum-ascites concentration gradient in albumin (SAAG) was low in 68.6% of cases and high in 31.4% of cases
In the case of high SAAG, 91% of ascites related to portal hypertension (PHT) were observed, and 77.5% of a low SAAG corresponded to ascites related to PHT (p = 0.024) with Se = 35% Sp = 84% and accuracy = 44%
Summary
The causes of ascites are multiple, two etiologies predominate, liver cirrhosis for transudative ascites and peritoneal tuberculosis for exudative ascites in our contexts. In Africa in general and in sub-Saharan Africa in particular, much work has been done on ascites, but few studies have indicated the interest of SAAG in the etiological diagnosis of ascites [4] [5] [6] [7]. It is questionable whether SAAG has the same diagnostic value in the etiological research of ascites in Africans as in Caucasians. Our study aimed to clarify the interest of the ascites serum albumin gradient (SAAG) in the etiological diagnosis of ascites by assessing its threshold value in the diagnosis of cirrhosis and peritoneal tuberculosis in Black Africans
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