Ascitic Fluid Total Protein Research Articles

Specificity and Sensitivity of Ascitic Fluid Total Protein (AFTP) and Serum Ascitic Albumin Gradient (SAAG) in Diagnosis Etiology of Ascites

Specificity and Sensitivity of Ascitic Fluid Total Protein (AFTP) and Serum Ascitic Albumin Gradient (SAAG) in Diagnosis Etiology of Ascites

Ascites and Chronic Liver Disease in Children.

Development of ascites in children with chronic liver disease is the most common form of decompensation. It is associated with a poor prognosis and increased risk of mortality. A diagnostic paracentesis should be performed in liver disease patients with- new-onset ascites, at the beginning of each hospital admission and when ascitic fluid infection (AFI) is suspected. The routine analysis includes cell count with differential, bacterial culture, ascitic fluid total protein and albumin. A serum albumin-ascitic fluid albumin gradient of ≥1.1g/dL confirms the diagnosis of portal hypertension. Ascites has been reported in children with non-cirrhotic liver disease like acute viral hepatitis, acute liver failure and extrahepatic portal venous obstruction. The main steps in management of cirrhotic ascites include dietary sodium restriction, diuretics and large-volume paracentesis. Sodium should be restricted to maximum of 2mEq/kg/d (max 90mEq/d) of sodium/day. Oral diuretic therapy comprises of aldosterone antagonists (e.g., spironolactone) with or without loop-diuretics (e.g., furosemide). Once the ascites is mobilized, the diuretics should be gradually tapered to the minimum effective dosage. Tense ascites should be managed with a large-volume paracentesis (LVP) preferably with albumin infusion. Therapeutic options for refractory ascites include recurrent LVP, transjugular intrahepatic porto-systemic shunt and liver transplantation. AFI (fluid neutrophil count ≥250/mm3) is an important complication, and requires prompt antibiotic therapy. Hyponatremia, acute kidney injury, hepatic hydrothorax and hernias are the other complications.

Assessment of adenosine deaminase levels and lypmhocyte counts in tubercular ascitis

Ascitis is the pathological accumulation of free fluid within the peritoneal cavity. Ascitis is manifestation of number of diseases. Traditional classification of ascitis into “Exudative” and “Transudative” which involves estimation of ascitic fluid total protein, which is ≥ 2.5 g/dl in exudates and <2.5 g/dl in transudate. To estimate and compare the ascitic fluid ADA levels between the tubercular ascitis and non-tubercular ascitis and to correlate the levels of ascitic fluid ADA with total protein, albumin, sugar, SAAG and lymphocytes in subjects with tubercular ascites. In our study, we included a total of 140 subjects, out of which 21 (15%) subjects had tubercular ascitis. Out of 140 subjects 105 of them had cirrhosis of liver and 35 of them had ascitis due to other causes. Biochemical analysis for Protein, albumin, LDH and Glucose were performed on Automated Biochemistry Analyser and ADA was estimated by ADA-MTB kit method. The mean levels of total protein and albumin in Group T were 5.4±0.98 and 3.4±0.96 and in Group NT were 2.2±1.1 and 3.2±1.1 respectively. There were statistically significant elevated levels of total protein and decreased albumin in Group T as compared to Group NT.

Aetiology, Clinical Presentation and Outcome of Patients with Ascites in Medicine Unit of Chittagong Medical College Hospital : A Study of 100 Cases

Background: Ascites is a common clinical condition encountered by physician in day-to-day practice. It will be an understatement to state that ascites is common in our country rather it is safe to say that ascites is one of the most common mode of presentation in the hospital wards in our country. The aim of the study was to find out the common causes of ascites by evaluating the clinical presentations along with the ascitic fluid study and other routine and related investigations followed by observing the short-term outcome of the patients with ascites during their hospital tenure.
 Materials and methods: It is a descriptive observational study carried out in Medicine Department of Chittagong Medical College Hospital (CMCH) over a period of one year (October 2008- September 2009). Hundred consecutive adult patients admitted in different units of Medicine Department, CMCH with ascites were the subjects of this study. After selection of cases detailed clinical history was taken and elaborate physical examination was done. Common criteria for data collection were followed in every case. Ascitic fluid was collected and examined in all 100 cases. Selected investigations were designed considering the symptomatology and systems affected and reserved for those cases where symptoms and signs were strongly in favour of the diagnosis that needs to be investigated accordingly. All the data were computed and analysed with proper statistical methods.
 Results: Data analysis of the present study reveals that Cirrhosis of liver is the commonest cause of ascites (50%). Next two major causes are Tubercular Peritonitis (21%) and Congestive Cardiac Failure (14%). Other important causes include hepatocellular carcinoma (7%) Su-bacute Hepatic Failure (3%) Intra-abdominal malignancy (Except hepatocellular Carcinoma) (3%) and Nephrotic Syndrome (1%). Clinical presentations have shown that most of the patients had multiple and variable presentations. Serum ALP, AST, ALT, Ascitic Fluid Total Protein (AFTP) (F=5.04, p=0.0009 <0.05) Serum Ascitic Fluid Albumin Gradient (SAAG) are found to be statistically significant. Total 76% patients improved with treatment, condition of 11% patients were static and 1% deteriorated. 9% patients of this study died during hospital stay in spite of appropriate treatment measures. 3% of them died of grade IV hepatic encephalopathy, 2% died of complications of very late stage of congestive cardiac failure. Rest 4% were case of hepatocellular carcinoma on top of cirrhosis of liver.
 Conclusion: Results of this study offers an overview of aetiology, clinical presentation and short-term outcome of the patients with ascites reporting to a tertiary level hospital in this zone.
 IAHS Medical Journal Vol 4(2), June 2021; 56-62

51-Year-Old Man With Ascites and Abdominal Pain

51-Year-Old Man With Ascites and Abdominal Pain

Comparison of Diagnostic Accuracy of Portal Serum Ascitic Albumin Gradient (SAAG) with Ascitic Fluid Total Protien (AFTP) Differentiating Portal Hypertension from Non-Portal in Patients with Ascites

Introduction: Although majority of the cases of ascites have cirrhosis, there are 15% patients where there is a non-hepatic cause of fluid retention like malignancy, congestive heart failure and tuberculous peritonitis. Ascites is the most common complication of cirrhosis that leads to hospital admission. Objective:To compare the diagnostic Accuracy of Serum Ascitic Albumin Gradient (SAAG) and Ascitic Fluid Total Proteins in patients with ascites by taking Ultrasound abdomen & Pelvis as gold standard. There are international studies on the accuracy of SAAG in determining cause of ascites but not much local data. Additionally, SAAG is not widely used in our setup. The results of this study will add to the existing knowledge and will help in the diagnosis and better management of these patients. Material & Methods: A cross sectional validation study was conducted in the department of General Medicine, DHQTH, Dera Ismail Khan from 29th April to 29th Oct, 2019. Diagnostic Ascitic fluid was aspirated from the peritoneal cavity and ascitic fluid was sent to hospital laboratory for total protein and albumin. Blood was taken at the same time and was send to the hospital laboratory for the serum albumin. SAAG was calculated by subtracting ascitic albumin value from the serum albumin value. Both, Ascitic fluid total protein and SAAG values was documented in the proforma. Ultrasound Abdomen & Pelvis was done on each patient with special instruction for radiologist to comment upon Portal Vein diameter and any changes in its diameter with respiration. Results: As per comparison Of SAAG with ultrasound in detecting ascites, sensitivity was 36.26%, specificity was 75%, PPV was 84.62%, NPV was 23.68% and accuracy was 44.35%. P Value was 0.299. As per comparison of AFTP with ultrasound in detecting ascites, sensitivity was 33.33%, specificity was 59.34%, PPV was 17.78%, NPV was 77.14% and accuracy was 53.91%. P value was 0.513. Conclusion:SAAG exhibits that patients with ascites fluid possess the basis of portal hypertension. Thus we have come to this conclusion that SAAG can effectively enhance the diagnostic value of ascites fluid tests and therefore its classification can be considered to be a novel standard in the analysis of ascites fluid. Keywords: Diagnostic Accuracy, Ascites Volume, Ascitic Albumin Gradient (SAAG), Ascitic Fluid Total Proteins (AFTP)

Change of the Ascitic Fluid Total Protein in Natural Progression of Liver Cirrhosis and Serum Ascites Albumin Gradient in Patients with Spontaneous Bacterial Peritonitis Versus Patients with Cirrhosis and Sterile Ascites

Change of the Ascitic Fluid Total Protein in Natural Progression of Liver Cirrhosis and Serum Ascites Albumin Gradient in Patients with Spontaneous Bacterial Peritonitis Versus Patients with Cirrhosis and Sterile Ascites

Clinical usage of serum albumin to ascitic fluid albumin gradient and ascitic fluid total protein in pediatric ascites

Abdominal paracentesis is performed as a diagnostic test in children with ascites. Serum albumin to ascitic fluid albumin gradient (SAAG) is frequently used in adults to distinguish types of portal hypertension. We aim to investigate the utilization of SAAG and other biomarkers in determining the etiology of significant ascites in children. In this retrospective study, children aged 0-21 years with significant ascites were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and medical records during the period 1983-2010. Medical records of children who had abdominal paracentesis were examined in detail. 207 children had significant ascites and of those children, 20 (9.6%) had abdominal paracentesis. Our data showed that high albumin gradient (SAAG ≥ 1.1 g/dL) differentiates causes of ascites secondary to portal hypertension (cirrhosis, hepatic vein outflow obstruction, or congestive hepatopathy) from other causes. In addition, ascitic fluid total protein (AFTP) may help in differential diagnosis of ascites. Children with high SAAG manifest clinical features of portal hypertension including esophageal varices or variceal hemorrhage. Among patients with initially unclear causes of ascites, SAAG and AFTP can provide guidance for appropriate investigations.

Analysis of ascitic fluid in differentiating transudate versus exudate - in a tertiary care centre

Introduction: Ascites is the accumulation of fluid within the peritoneal cavity. Normally, 5-20ml of peritoneal fluid is found between the layers of peritoneum, acting as a lubricant and reducing the friction of organ movement during digestion and bodily movements. The use of serum ascites albumin gradient has out dated the total protein measurement in differentiating transudate from exudate fluid. Analysis is done in two broad spectrums: (1) Biochemical analysis (2) Clinical pathology and Cytological analysis Aim & Objectives: This study was done with the objective to evaluate the ascitic fluid analysis for differentiating transudate versus exudate and also the characteristics of the peritoneal fluid in various causes of ascites. Materials and Methods: In this study, 100 patients of ascites were evaluated for ascitic fluid total protein (AFTP) and Serum Albumin Ascitic Gradient (SAAG) along with ultrasound and other required investigations. Ascitic fluid was obtained by Paracentesis, an invasive sampling procedure to remove fluid or air from the peritoneal cavity for diagnostic or therapeutic purposes. The fluid obtained is sent for analysis. Ascitic fluid analysis is a group of tests used to diagnose the etiology of fluid accumulation. Result: Study shows that ascites due to various aetiology is common among 31-50 years of age group with a slight male predominance. The present study suggests that transudative ascites are more common than exudative ascites with a percentage of 52%. Conclusion: Serum Albumin Ascitic Gradient (SAAG) is much more superior to ascitic fluid total protein (AFTP) in the differential diagnosis of Ascites. Ascitic fluid analysis helps in diagnosing the aetiology of ascites based on the cytological and biochemical parameters. The common aetiology for ascites reported in India is liver cirrhosis. The development of ascites in cirrhotic patients is associated with a mortality of 15% and 44% at one-year and five-year follow-up periods, respecti

Diagnostic Value of Ascitic Fluid Total Protein in Differential Diagnosis of Ascites: A Prospective Multicenter Study

Background: Diagnostic performance of ascitic fluid total protein (AFTP) concentration remained unsettled. Our aim was to determine diagnostic value of AFTP in differential diagnosis of ascites. Methods: 704 consecutive patients with new-onset ascites were prospectively enrolled in this study. Findings: In the training cohort, diagnostic performance of quantitative AFTP assay was superior to that of Rivalta test in differential diagnosis of ascites. At the pre-determined cut-off value of 25 g/L, quantitative AFTP assay was more useful in the differentiation of non-portal hypertensive ascites from portal hypertensive ascites compared with the exudate-transudate classification, area under curve (AUC) of receiver operating characteristic (ROC) curve was 0.958. Quantitative AFTP assay was superior to serum-ascites albumin gradient (SAAG) in the detection of non-portal hypertensive ascites, especially malignant ascites and tuberculous peritonitis. In mixed ascites, AFTP was useful in identifying peritoneal lesions. Interpretation: Assay of AFTP represents a beneficial adjunct to SAAG in non-portal hypertensive ascites and mixed ascites, thus it should be determined in diagnostic workup of the patients with ascites. Funding: This work was partially supported by National Natural Science Foundation of China and Clinical Research Physician Program of Tongji Medical College, Huazhong University of Science and Technology. Declaration of Interest: None. Ethical Approval: Our study was conducted in accordance with the principle of Declaration of Helsinki, and also approved by Ethics committee of Tongji Medical College, HUST. This study was registered with the Chinese Clinical Trial Registry Platform (http://www.chictr.org.cn/) as ChiCTR-DCD-15006907.

A comparative study of serum ascitic fluid albumin gradient with ascitic fluid total protein in evaluating the etiology of ascites

Background: The traditional method of classification of ascites by AFTP offers little insight into the pathophysiology of ascites formation and it has many drawbacks. In order to overcome it, the classification of ascites based on SAAG has emerged. Even SAAG has some draw backs like non correlation with ascites due to non-alcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. This study is conducted to compare the diagnostic accuracies of SAAG and AFTP in identifying the pathophysiology of ascites.Methods: A total of fifty patients who were admitted with ascites were included in the study. Ascitic fluid total protein and SAAG were calculated. They were classified on the basis of SAAG into High SAAG and Low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures, the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated sepereately. The diagnostic accuracies of SAAG and AFTP were compared statistically.Results: The sensitivity of SAAG was found to be 86.84% and that of AFTP 60%. The specificity of SAAG was found to be 83.33% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG was found to be 86% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG and AFTP for individual etiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.Conclusions: The sensitivity and specificity of SAAG was superior to AFTP in identifying the etiology of ascites.

Ascitic fluid total protein, a useful marker in non-portal hypertensive ascites.

Diagnostic performance of ascitic fluid total protein (AFTP) concentration remained unsettled. Our aim was to determine diagnostic value of AFTP in differential diagnosis of causes of ascites. Seven hundred four consecutive patients with new-onset ascites were prospectively enrolled in this study. In the training cohort, diagnostic performance of quantitative AFTP assay was superior to that of Rivalta test in differential diagnosis of ascites. At the predetermined cut-off value of 25g/L, quantitative AFTP assay was more useful in the differentiation of non-portal hypertensive ascites from portal hypertensive ascites compared with the exudate-transudate classification, area under curve of receiver operating characteristic curve was 0.958. Quantitative AFTP assay was superior to serum-ascites albumin gradient in the detection of non-portal hypertensive ascites, especially malignant ascites and tuberculous peritonitis. In mixed ascites, AFTP was useful in identifying peritoneal lesions. Ascitic fluid total protein is a useful marker in non-portal hypertensive ascites; thus, it should be determined in diagnostic work-up of the patients with ascites.

Assessment of calprotectin in ascitic fluid as a marker for spontaneous bacterial peritonitis diagnosis in cirrhotic patients

BackgroundSpontaneous bacterial peritonitis (SBP) is a serious infection of ascitic fluid in cirrhotic patients. High mortality associated with the delay in diagnosis and treatment. There is a need for an accurate and a rapid method for SBP diagnosis.ObjectivesWe aimed to evaluate ascitic fluid calprotectin as a diagnostic marker for SBP.Patients and methodsForty four cirrhotic patients were divided into two groups, non-SBP group: 22 patients with cirrhotic ascites without evidence of SBP and SBP group: 22 patients with cirrhotic ascites and SBP diagnosed by positive ascitic fluid bacterial culture and an increase in polymorphonuclear leukocytes (PMNLs) count in ascites (≥250 cells/mm3). Ascitic fluid calprotectin levels were measured using enzyme-linked immunosorbent assay.ResultsThere was a significant increase of ascitic fluid calprotectin, total leukocytic count, PMNLs, lactate dehydrogenase, and total protein in SBP group when compared to non-SBP group. There were significant positive correlations between white blood cell, ascitic fluid total leukocytic count, PMNLs, total protein, and model for end-stage liver disease score values and ascitic fluid calprotectin among SBP group. Ascitic fluid calprotectin with cutoff value 620 ng/ml, showed a sensitivity of 90.91% and a specificity of 95.45%, in diagnosis of SBP with positive predictive value 95.2% and negative predictive value 91.3%.ConclusionAscitic fluid calprotectin may be valuable in rapid diagnosis of SBP.

SPONTANEOUS BACTERIAL PERITONITIS

Objectives: To find out the diagnostic accuracy of ascitic fluid LactateDehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absoluteneutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design:Cross sectional (validation) study. Setting: This study was conducted in department ofMedicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting afterapproval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluidwas withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cellcount, total protein, albumin and LDH wascalculated along with serum albumin and serumLDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer,serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin fromserum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratiowas calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derivedfrom total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years,53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standardwas recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenasein diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil countequal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%,88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictivevalue and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negativelikelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluidLactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using asciticfluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard.

Low ascitic fluid total protein levels is not associated to the development of spontaneous bacterial peritonitis in a cohort of 274 patients with cirrhosis

Background: Spontaneous bacterial peritonitis (SBP) is a complication to decompensated cirrhosis. Fluoroquinolones may prevent SBP. However, predictive markers for SBP are wanted. Guidelines suggest that patients with ascitic fluid protein below 15 g/l receive fluoroquinolones to prevent SBP. This study aimed to assess the clinical utility of low ascitic fluid protein in predicting SBP in patients with cirrhosis and ascites.Methods: A total of 274 patients with cirrhosis and ascites underwent paracentesis between January 2010 and June 2015. Patients were followed until two years, development of SBP, initiation of ciprofloxacin, death or liver transplantation. Data were compared between groups of patients with ‘high’ or ‘low’ ascitic protein.Results: SBP developed in 31 patients (11.3%). No difference in mean ascitic fluid protein levels were found (SBP, mean: 8.5 g/l and no SBP 8.2 g/l, p = .825). SBP developed at equal rates in patients with ‘high’ or ‘low’ ascitic protein (10.8% (≤15 g/l) and 14.0% (>15 g/l), p = .599). The same trend was observed when adjusting the threshold below 10 g/l (11.9% (≤10 g/l) and 10.2% (>10 g/l), p = .697).Conclusions: Low ascitic fluid protein does not predict SBP in patients with cirrhosis and ascites. Better markers are needed.

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

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.

A Comparative Study of Serum-Ascitic Fluid Albumin Gradient (SAAG) and Ascitic Fluid Total Protein (AFTP) as a Diagnostic Parameter in Patients Having Ascites

Ascites is a manifestation of various number of diseases and the aetiopathogenesis of ascites is varied. The differential diagnosis of ascites remains a clinical problem. Although cirrhosis is the cause of ascites in most patients (80%), approximately 20% have a cause other than liver disease. Approximately 5% of patient with ascites have more than one cause (i.e. ‘mixed’ ascites). The present study was conducted on 75 consecutive patients admitted to indoor wards, Department of Medicine, Mayo Institute of Medical Science, Barabanki (UP), between June 2015 to May 2016 of age group 18–70 years having clinical symptoms and signs of ascites. Samples of blood and ascitic fluid were obtained simultaneously. The aim of present study was to evaluate various parameters especially serum ascitic fluid albumin gradient in case of ascites in an Indian setting and to compare the SAAG with the AFTP levels in terms of usefulness in establishing a cause of ascites. In the present study value of SAAG was 1.56 ± 0.37 gm/dl (mean ± standard deviation) for patients with portal hypertension related ascites whereas for non-portal hypertension related ascites excluding cardiac ascites SAAG was 0.95 ±0.14 gm%. Corresponding values for cirrhosis and cardiac ascites were 1.6 ± 0.39 gm/dl and 1.44 ± 0.21 gm/dl respectively. It was observed that SAAG in cardiac ascites group (even though placed in non portal hypertension related ascites group based on absence of portal hypertension) resembled the SAAG of portal hypertension related ascites group. It was concluded from our present study that serum ascitic fluid albumin gradient(SAAG) is a better diagnostic parameter than ascitic fluid total protein (AFTP) in the patients having ascites. During the study we observed that SAAG has greater sensitivity and specificity values in comparision to AFTP for detection of portal hypertension related ascites.

Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients

BACKGROUND and AIM: Delayed diagnosis of spontaneous bacterial peritonitis (SBP) is associated with high mortality in cirrhotic patients. Therefore, there is a need for a rapid non-invasive diagnostic tool. This work aimed at evaluating the role of serum calprotectin as a non-invasive diagnostic marker for SBP in comparison to C-reactive protein (CRP). METHODS: 75 cirrhotic patients were included and divided into three groups. Group A: 25 patients with cirrhotic ascites and SBP diagnosed by presence of PMNL ≥ 250/mm 3 in ascitic fluid with or without positive ascitic fluid culture. Group B: 25 patients with cirrhotic ascites without SBP. Group C: 25 cirrhotic patients with no clinical or ultrasound evidence of ascites as a control group. All were subjected to complete clinical evaluation, routine laboratory investigations, serum calprotectin, CRP levels and diagnostic abdominal paracentesis (only for group A and B). RESULTS: Group A showed significantly higher levels of ascitic fluid total leukocytic count, polymorphonuclear leukocytes and total protein (P<0.001) in comparison to Group B. Group A had significantly higher serum calprotectin and CRP levels than other groups. There were significant positive correlations between serum calprotectin and serum WBC, CRP and ascitic fluid TLC, PMNL and total protein among group A. Serum calprotectin and CRP had the most significant diagnostic performance in detection of SBP (AUC=0.976 and 1.000 respectively, P<0.001). A cut-off level of serum calprotectin≥46.0 μg/mL showed a sensitivity of 100%, specificity 92% and diagnostic accuracy 96%; while that of CRP≥9.0 mg/dL showed a sensitivity of 100%, specificity 100% and diagnostic accuracy 100%. CONCLUSION: Serum calprotectin in combination with CRP may be useful for non-invasive diagnosis of SBP.

Clinical profile and comparison of SAAG with ascites fluid total protein (AFTP) in cases of ascites at a tertiary referral hospital in Maharashtra

Aims: This observational prospective study was carried out with aims of 1) study various presentations and clinical features in ascites cases, 2) assess different etiological factors, 3) compare serum ascitic albumin gradient (SAAG) and ascitic fluid total protein (AFTP) in differentiating portal hypertension related causes of ascites from others, 4) study in hospital outcome in cases of ascites . Material and Methods : 100 consecutive ascites cases admitted in wards with clinical diagnosis and sonographic confirmation were recruited in the study. After history and detailed clinical examination cases were subjected to ultrasonography and portal vein Doppler to diagnose portal hypertension which was followed by paracentesis. Serum Albumin & total protein, ascitic fluid albumin and total protein, AFTP and SAAG was determined. Results : Mean age of diagnosis of ascites was 42.41 ±7.72 years and maximum cases in 30-49 years age group. 68% of cases of ascites had cirrhosis of liver, 16% peritoneal (abdominal) tuberculosis, 10% chronic heart failure (CHF), 4% nephrotic syndrome and 2% had ovarian malignancy. Mean AFTP and Mean SAAG was 1.77±0.73gm% and 2.05±0.52 gm% in 78 cases of portal hypertension related ascites respectively. In normal portal pressure cases (n=22) of ascites it was 3.01±0.37 gm% and 0.72±0.19 gm% respectively. Sensitivity of AFTP and SAAG in differentiating portal hypertension related etiology from other causes was 70.51% and 92.31% respectively .Though sensitivity was less, specificity was equal ( 95.45%). Eight cases had variceal bleeding, 9 had hepatorenal syndrome and 15 had hepatic encephalopathy. Total 16 cases of liver cirrhosis with ascites died in hospital commonest cause was hepatic encephalopathy and hepatorenal syndrome.

The diagnostic utility of serum ascites albumin gradient against ascitic fluid total protein for detection of liver disease in patients of ascites- A comparative study

Introduction: Various studies have demonstrated superiority of SAAG (serum ascites albumin gradient) in classifying ascites compared to transudate-exudate concept but with conflicting observations. Ascitic fluid total protein (AFTP) level in ascitic fluid is a much cheaper alternative to the serum ascites albumin gradient ratio. Hence in the study, we have compared the diagnostic accuracy of the old cheaper traditional method against the new method. Methods: Total 102 patients of Ascites were included in the study from J.A. group of hospital, G.R.Medical College (M.P.) in year 2013-15. All medical causes of ascites were included in our study and Non medical causes were excluded. The collected data was analyzed by using Pearson Chi-square statistical analysis to determine correlation between variables. Result: For prediction of liver disease it was found that SAAG was significantly (p value 0.0341) more predictive of Liver disease compared to AFTP. SAAG (p value<0.0009) and AFTP (p value 0.49) were both significant for differentiating cause of ascites when comparison was done between liver and non-liver disease. Conclusion: AFTP is a good surrogate marker for detection of liver disease in ascites. AFTP is an excellent diagnostic test for detection of certain extra hepatic diseases leading to ascites like tubercular peritonitis sub-acute bacterial peritonitis and anaemia-hypo-proteinemia.e