Serum-ascites Albumin Gradient Research Articles

Ascites Is a Poor Prognostic Factor in Advanced Pancreatic Adenocarcinoma and May Be Undertreated: A Prospective Cohort Study.

Pancreatic ductal adenocarcinoma is associated with significant morbidity and mortality as most patients present with advanced disease. The development of ascites has been associated with poor outcomes and further characterization and contemporary management strategies are needed. A total of 437 patients enrolled in the Gastrointestinal Biobank at Cedars-Sinai Medical Center who had epithelial pancreatic malignancy were included in the prospective cohort group. Overall, 41.7% of patients included in this study developed ascites. Most patients with ascites (>80%) had high serum-ascites albumin gradient ascites. In both univariate and multivariate analysis, a history of ≥1 form of chemotherapy was significantly associated with ascites. Estimated median overall survival in patients with ascites was significantly lower than in patients without ascites, 473 days vs 573 days, and ascites had a hazard ratio of 1.37. Patients with ascites who received diuretics and indwelling peritoneal catheter had an estimated median survival of 133 days from diagnosis of ascites, and those who received only the indwelling peritoneal catheter without diuretics had an estimated median survival of only 54 days. The estimated median survival from the diagnosis of ascites was 92 days, and the median time to puncture was 7 days. The median time from first tap to death was 45 days. The use of diuretics is lower than would be expected for patients with pancreatic ductal adenocarcinoma with elevated serum-ascites albumin gradient. Other therapies such as beta blockers should be investigated in this subset of patients. The etiology of ascites in these patients is poorly understood, and further research is needed to establish treatment guidelines and improve outcomes.

Analysis of serum ascites albumin gradient (SAAG) in cats with hepatic disorder

Three Persian breed cats were diagnosed to be having hepatitis. Clinical examination revealed dullness, dehydration, poor body condition and fluid thrill on the abdominal palpation. Radiography and ultrasonography revealed ground glass appearance of the abdomen and anechoic fluid in the abdomen respectively. Elevated serum ascites albumin gradient with elevated serum alanine transaminase levels were noticed in these cats

Ascitis en el paciente no cirrótico

Ascites, defined as the abnormal accumulation of fluid in the peritoneal cavity, is mainly due to cirrhosis and portal hypertension (PHT). However, in 20% of cases, it is not related to these diseases. Given its varied etiology, it is essential to study it in order to determine therapeutic management. The pathophysiology of non-cirrhotic ascites is not usually related to cirrhosis-associated PHT, and understanding these mechanisms facilitates the etiologic diagnosis. Symptoms include abdominal distension, weight gain, postprandial fullness, and even dyspnea. The physical examination may be normal in cases of very mild ascites. An increase in abdominal circumference may be identified in more advanced or severe cases and signs associated with the underlying disease may also appear. The International Club of Ascites classification categorizes it according to the amount and abdominal distension. The initial evaluation includes a medical history, physical examination, abdominal ultrasound, and ascitic fluid analysis. Diagnostic paracentesis is crucial for identifying the cause, analyzing characteristics of the fluid such as its appearance and content, especially the protein concentration and the serum ascites albumin gradient, which will allow differentiating the different causes. In Western countries, the most frequent causes are tumor and heart diseases while in developing countries, infectious diseases, especially tuberculosis, are the most prevalent.

Possible use of 2D shear wave liver elastography in new-onset ascites evaluation

BackgroundNo data on the use of 2D shear wave elastography exists regarding the evaluation of the new-onset ascites causality.AimsTo determine whether 2D shear wave elastography can help in the non-invasive assessment of the new-onset ascites cause. To assess the applicability of liver stiffness measured by 2D shear wave elastography using Esaote MyLab Nine apparatus in patients with ascites.MethodsIn 52 consecutive patients with new-onset ascites (January 2020 to October 2021), liver stiffness using 2D shear wave elastography was prospectively measured. The reliable measurements were used for further analysis. Relevant clinical and laboratory data was collected.ResultsThe calculated liver stiffness measurement cut-off value of 14.4 kPa held 94% accuracy, 100% sensitivity, and 83% specificity when determining ascites with serum ascites albumin gradient ≥11 g/L. Reliable 2D shear wave elastography success rate was 84%.Conclusions2D shear wave elastography may potentially be used to differentiate transudative from exudative ascites, especially in patients with portal hypertension and peritoneal carcinomatosis.

Aetiology and diagnostic utility of serum ascites albumin gradient in children with ascites

BackgroundAscites in children is multifactorial and serum ascites albumin gradient (SAAG) ≥1.1 helps differentiate portal hypertension (PHTN) related from non-PHTN ascites. AimsWe evaluated the aetiology and diagnostic accuracy of SAAG in children with ascites. MethodsChildren with ascites were retrospectively evaluated. Etiological diagnosis was based on clinical presentation and investigations. All cases with ascitic fluid analysis and a definite diagnosis were included for calculating the utility of SAAG. ResultsWe enrolled 878 children (568[64.7%] boys). Majority were PHTN related (638[72.7%]) and secondary to acute viral hepatitis (98,15.4%), acute liver failure (185,29%), chronic liver disease (276,43.3%) and Budd-Chiari syndrome (79,12.4%). Other causes included tubercular (46,5.2%), pancreatic (32,3.6%), chylous (20,2.3%), biliary (12,1.4%), pseudoascites (16,1.8%), infections (46,5.2%), nephrotic (26,2.9%), malignancy (23,2.6%), cardiac (9,1.0%) and others (10,1%). SAAG (n = 305) correctly differentiated PHTN and non-PHTN ascites in 272 (89.2%) cases, with a high sensitivity (97%), specificity (93%) and diagnostic accuracy (95.8%). Reasons for inaccurate SAAG included mixed ascites (n = 9), different day serum and ascitic fluid albumin estimation (n = 5), serum albumin ≤1.1 g/dL (n = 2), chylous ascites (n = 3), hypergammaglobulinemia (n = 1), albumin infusions (n = 1) and unexplained (n = 12). ConclusionsNearly 27% children had non-PHTN related ascites. SAAG differentiates PHTN from non-PHTN ascites with a diagnostic accuracy of 95%.

Severe Mitral Stenosis Presenting as Chronic Liver Disease: A Rare Case Report

High Serum Ascites Albumin Gradient (SAAG) ascites in severe rheumatic mitral stenosis is very uncommon. Hereby, the authors present a similar case with this rare combination. The present case report describes a 42-year-old male with no history of hypertension or diabetes, but occasional alcohol consumption, who presented to department with complaints of recurrent anasarca over the past five years. The electrocardiogram showed an irregular R-R interval with no P waves, indicating atrial fibrillation. Ascitic fluid analysis revealed a high serum ascites albumin gradient with low ascitic protein levels. The patient responded well to treatment and was discharged with appropriate medications. He was referred to a higher centre with cardiothoracic surgical facilities for mitral valve replacement and tricuspid annuloplasty. The present case report highlights the uniqueness of the combination of severe rheumatic mitral stenosis and ascites.

Differential diagnosis of ascites: etiologies, ascitic fluid analysis, diagnostic algorithm.

Ascites is the pathological accumulation of fluid within the peritoneal cavity. It often occurs as results of liver cirrhosis, malignant neoplasia, tuberculous infection, cardiac insufficiency, renal diseases, etc. Determining the etiology is an essential step in the management of patients with new-onset ascites. Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most cost-effective method of determining the cause of ascites. We performed a literature search of PubMed and identified articles published in the field of ascites, to evaluate diagnostic values of various parameters in defining the etiologies of ascites and then provides diagnostic algorithm for patients with new-onset ascites. In patients with ascites, the constituent ratio of underlying etiology varies between developed and developing countries. It is a challenge to define the etiologies of ascites in developing countries. Routine ascitic fluid analysis should include the serum ascites albumin gradient (SAAG), total protein concentration, cell count and differential. Optional ascitic fluid analysis includes cholesterol, fluid culture, cytology, tumor markers, lactate dehydrogenase, adenosine deaminase (ADA), triglyceride, amylase, glucose, brain natriuretic peptide (BNP), etc. Our review evaluated diagnostic values of the above parameters in defining the etiologies of ascites. Diagnostic algorithm established in this review would provide a practical and convenient diagnostic strategy for clinicians in diagnosing patients with new-onset ascites.

Case Report On Diagnosis of Malignancy with Serum-Ascites Cholesterol Gradient

Ascites are the accumulation of fluid in the Abdomen. It happens due to clinical complications from various diseasesthat cause signs and symptoms. Cirrhosis, malignant ascites, and abdominal tuberculosis are the most common causes of ascites.The multiple etiologies of ascites make determining the cause difficult. Several techniques can aid in the differential diagnosis ofascites. However, the techniques are more expensive, invasive, and require more time. As a result, a less expensive and fastermethod of diagnosis, at least as a screening test, would greatly benefit clinicians. Albumin and Cholesterol in serum and ascitic fluidare parameters that would help screen and diagnose cancer. The serum-ascites albumin gradient or gap (SAAG) is a medicalcalculation that helps determine the cause of ascites. In addition, the serum ascites cholesterol gradient (SACG) aids in thedifferential diagnosis.The case study aims to evaluate the significance of serum-ascites cholesterol gradient (SACG) in diagnosingovarian carcinoma. This case report includes a 53-year-old woman who presented to the surgical department with anorexia,indigestion, heartburn, pain or discomfort in the abdominal and pelvic regions, nausea, early satiety, bloating, and weight loss for1 month. She was diagnosed with ovarian carcinoma. The gradients of serum-ascites albumin and serum-ascites Cholesterol werecalculated. Later, the results were compared to Ca-125, an ovarian cancer marker. SAAG showed low sensitivity but high specificityand poor diagnostic performance. Her diagnosis of ovarian carcinoma was confirmed and she was advised to follow up with theoncologist. The current case report will help understand the contribution of the ascitic fluid and serum parameters in a case ofovarian cancer with ascites of unknown etiology.

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

CLINICAL PROFILE OF ASCTES BASED ON PRESENTATION AND LABORATORY FINDINGS:AN INSTITUTIONAL EXPERIENCE FROM MAHARASHTRA,INDIA

Introduction: Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualised. Aim: To study clinical profile of ascites based on presentation and laboratory findings Methods: This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Maharashtra . One hundred fourteen patients with ascites under regular follow up of SMBT Hospital were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated. Results: Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/decilitre in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Albumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites. Conclusions: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.

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.

Role of Serum Ascites Albumin Gradient In The Etiologic Diagnosis of Ascites

Background: Classification based on ascitic fluid protein has been challenged on several occasions in diverse clinical situations, including cirrhotic patients on extended diuretic treatment, cardiac ascites, 1/3 individuals with malignant ascites, spontaneous bacterial peritonitis, and even normal ascitic fluid. Objective: The study’s objective was to observe the role of serum ascites albumin gradient (SAAG) in diagnosing Ascites. Methods: This cross-sectional observational study was conducted at the Department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh. with a total of 100 participants with ascites following the inclusion and exclusion criteria of the study. Result: The most prevalent cause of ascites was cirrhosis, observed in 56% of the participants. Among the 56 cirrhosis patients, mean ± S.D. values of AFTP, AFAlb, SAlb, and SAAG were 2.1±1.2, 0.8±0.6, 3.1±0.7, and 2.2±0.7 respective units accordingly. According to ascitic fluid albumin values, a statistically significant relation was observed between cirrhosis and tuberculosis (P<0.01) and cirrhosis vs malignancy (P<0.01) cases. According to serum ascitic albumin gradient values, a similar significant association was also found between cirrhosis vs tuberculosis (P<0.01) and cirrhosis vs malignancy (P<0.01) cases. Conclusion: SAAG is an essential laboratory tool for the correct aetiological diagnosis of ascites. J Dhaka Med Coll. 2022; 31(1) : 120-124

Correlation between serum ascites albumin gradient and esophageal varices in patients with chronic liver disease

Background Liver cirrhosis is a major source of morbidity and mortality. Esophageal varices and ascites are common complications of portal hypertension. In newly diagnosed cirrhotic patients, endoscopic screening for varices is suggested. This increases the costs and overloads endoscopy units. Aim To study the relationship between serum ascites albumin gradient (SAAG) and presence and severity of esophageal varices in patients with chronic liver disease to validate the use of SAAG as an indirect indication of varices existence. Patients and methods The study was done on 50 adult cirrhotic patients presenting with ascites. Patients were evaluated for laboratory investigations and abdominal ultrasonography. Esophagogastroduodenoscopy was done to find out if varices are present and their severity. Diagnostic paracentesis was done for ascitic fluid examination, and SAAG value was calculated. Based on SAAG value, patients were divided into three groups. Results There was a significant difference in the distribution of varices between SAAG groups. At cutoff value of SAAG of greater than equal to 1.5, the occurrence of varices can be predicted with 76% accuracy, sensitivity of 77%, and specificity of 75%. Conclusions There is a directly proportional significant relation between SAAG value and the presence of esophageal varices, as well as their severity. A cutoff value of SAAG of greater than equal to 1.5 can be used for prediction of varices existence. Accordingly, SAAG could be used to predict the development of varices among other noninvasive predictors.

PREDICTION OF ESOPHAGEAL VARICES BASED ON SERUM-ASCITES ALBUMIN GRADIENT (SAAG) IN CIRRHOTIC PATIENTS

1.Introduction Cirrhosis is the end stage of chronic liver disease. Ascites and esophageal varices (EVs) are the most common complications of portal hypertension (PHT), with an incidence of approximately 50% [1]. Since effective preventive modalities have been established for variceal haemorrhage, early detection of EVs is critical for primary prevention of bleeding. Upper gastrointestinal endoscopy (UGE) remains the gold standard for screening [2,3]. However, many studies have been conducted to predict PHT and EV with a diverse rate of accuracy. All patients with cirrhosis should undergo UGE screening to identify those at high risk of bleeding and who may benet from primary prophylaxis, since EVs are an independent predictive factor and an early complication of cirrhosis. The test should also be repeated during the follow-up of patients with cirrhosis without EVs, who are at risk of bleeding, with or without decompensation [1]. Though UGiscopy is the gold standard to screen patients for variceal development; but has has many drawbacks such as being relatively expensive, invasive, and restrictive [4]. Such a screening test should be simple, rapid, reproducible, and inexpensive [5–7]. The serum ascites albumin gradient (SAAG) is a minimally invasive method that is precise and has been described in the classication of ascitic uid(AF) based on the presence or absence of PHT [8]. Many Studies have been performed to identify non-invasive parameters for the prediction of EVs in patients newly diagnosed with cirrhosis [5]. SAAG can be considered an indirect parameter for the detection of EVs and is useful in regions where there are limitations to perform UGE. The aim of our study was to evaluate the role of SAAG in the prediction of EVs in cirrhotic patients with ascites.

Outcomes after hospitalisation with spontaneous bacterial peritonitis over a 13-year period: a retrospective cohort study.

Assess outcomes in patients with an index presentation of spontaneous bacterial peritonitis (SBP) over a 13-year period. SBP, a bacterial infection of ascites, has a poor prognosis. Retrospective cohort study assessing mortality (standardised to 32 months) and prognostic factors in patients with SBP during two periods: period 1 (June 2006-November 2012) and period 2 (December 2012-May 2019). The study included 178 patients who were followed up for 11.6 (29.2) months. Mortality was high, with 12-, 24- and 32-month survival being 32%, 26% and 24%, respectively. Inpatient mortality was 36% with mortality in those surviving hospitalisation being 62%. Serum creatinine at the time of SBP diagnosis was an independent predictor of mortality at 32 months [hazard ratio (HR) 1.002, P = 0.023] and inpatient mortality (HR 1.003, P = 0.035). Positive ascitic fluid culture and ascitic fluid neutrophil count were independent predictors of 32-month (HR 1.679, P = 0.008) and inpatient mortality (HR 1.0001, P = 0.005), respectively. Patients in period 2 had lower ascitic fluid albumin (5.9 ± 3.3 g/L vs. 10.8 ± 5.4 g/L, P < 0.001), higher ascitic fluid neutrophil count (815.0 cells/mm3 vs. 345.0 cells/mm3, P < 0.001) and higher rates of hepatorenal syndrome-acute kidney injury (58 vs. 35%, P = 0.002). Mortality at 32 months and mortality in those surviving hospitalisation were similar at 78 vs. 73%, P = 0.392 and 66 vs. 58%, P = 0.355, for periods 1 and 2, respectively. Despite more advanced initial presentations, mortality rates have remained similar over the last 13 years. Serum creatinine at the time of SBP diagnosis is an independent predictor of mortality.

Risk factors, clinical indicators, and pathological findings of abomasal ulcers in tropical dairy buffaloes.

The current study aimed at identifying the risk factors and initial diagnostic aids for abomasal ulcers. The risk factor analysis confirmed a significant association (P < 0.05) of abomasal ulcers with concentrate-rich diets (OR, 4.795; CI, 1.212-15.974) and concurrent disorders (OR, 2.978; CI, 0.987-8.980), while the buffaloes in early lactation (OR, 2.777; CI, 0.703-10.972) showed a higher tendency (P = 0.078) for the disorder. The depressed demeanour, dark or black manure (melena), anemia, tachycardia, decreased milk production, anorexia, tachypnea, absence of rumination, abdominal guarding, kyphosis, and tachypnea were the most frequent clinical signs. Subjecting the abomasal fluid for cultural isolation, gram staining, and stormy clot fermentation test identified the presence of clostridium perfringes, while screening through uniplex PCR detected cpa toxin. The buffaloes affected with type-3 and 4 abomasal ulcers exhibited a higher peritoneal fluid to serum ratio of total protein, albumin, and glucose with a low (P < 0.01) serum-ascites albumin gradient (SAAG) concentration compared to reference values of healthy buffaloes. The first two principal components of PCA explained 54.50% of the total variances with lymphocytes, creatine kinase, and rumen chloride levels as the top contributors to dimension I, and albumin, total protein, sodium, and methylene blue reduction time (MBRT) for rumen liquor as the major contributors to dimension II. The vector plot revealed lymphocytopenia, decreased hemoglobin, hypoalbuminemia, hypokalemia, decreased rumen pH, neutrophilia, eosinophilia, leucocytosis, greater MBRT, and higher rumen chloride, serum creatine kinase, and blood urea nitrogen as the major indicators for abomasal ulcers. Histopathological studies revealed infiltration of inflammatory cells in the mucosa along with multifocal areas of necrosis, degeneration, and eroded muscle structure. The study projected a few high-scored clinical signs and extremely variable clinical indicators as initial diagnostic aids of abomasal ulcers, which can be confirmed by ultrasonography and peritoneal fluid examination.

A Rare Hemorrhagic, Orange-Colored Ascites, Challenging Traditional Ascitic Fluid Analysis.

Analysis of ascitic fluid can offer useful information in developing and supporting a differential diagnosis. As one of the most prevalent complications in patients with cirrhosis, ascitic fluid aids in differentiating a benign condition from malignancy. Both the gross appearance of the ascitic fluid, along with fluid analysis, play a major role in diagnosis. Here, we discuss a patient with liver cirrhosis, esophageal varices, hepatitis C, and alcohol abuse, who had a paracentesis performed, which revealed a turbid, viscous, orange-colored ascitic fluid that has not been documented in literature. Ascitic fluid is routinely analyzed based on gross appearance, cell count, and serum ascites albumin gradient (SAAG) score. An appearance of turbidity or cloudiness has commonly suggested an inflammatory process. In our case, fluid analysis revealed a red blood cell count of 24 250/mcL, further suggesting inflammation. However, it also revealed an insignificant number of inflammatory cells, with a total nucleated cell count of 14/mcL. This rich-orange color has posed a challenge in classification and diagnosis of the underlying cause of ascites, with one classification system suggesting inflammation, while another suggesting portal hypertension. Furthermore, we have traditionally relied on the SAAG score to aid in determining portal hypertension as an underlying cause of ascites. With a 96.7% accuracy rate, the SAAG score incorrectly diagnosed portal hypertension in this patient. In this article, we aim to explore how this rare, orange-colored ascitic fluid has challenged the traditional classification system of ascites.

Causes Of Ascites And Its Correlation With Serum-Ascites Albumin Gradient In Patients Admitted At Medical Wards In A Tertiary Hospital In Ghana.

Objective: Ascites can be classified depending on whether it results from portal hypertension (PH) or non-portal hypertension (NPH) causes. This classification is relevant because the modes of evaluation and management are different for these two groups. Serum-ascites albumin gradient (SAAG) has been proposed in many studies to categorise ascites better than ascetic fluid total protein. This has not been determined in Ghanaian patients with ascites. The aim of this study was to determine the aetiology of ascites and to assess the performance of SAAG in the classification of portal versus non-portal hypertension ascites among patients admitted to a tertiary hospital in Ghana.&#x0D; Methodology: A cross-sectional study was conducted at the Korle-Bu Teaching hospital, where 140 patients with ascites were recruited within the study period. Data on socio-demography, clinical features, and results of relevant laboratory investigations and imaging studies were collected using pretested questionnaires&#x0D; Results: The mean age of patients was 44.7±13.2 years. Chronic liver disease (CLD) was the major cause of ascites in this study representing 73.57%. SAAG had a sensitivity of 91.59%, positive predictive value of 95.15% and diagnostic accuracy of 90.0% in classifying ascites as due to a PH or NPH.&#x0D; Conclusion: CLD was the major cause of ascites in Ghanaian patients. SAAG has satisfactory diagnostic accuracy in differentiating ascites related to PH from NPH causes. This could be used as a first line investigation in the aetiological diagnosis of ascites for initiation of prompt treatment.

Diagnostic accuracy of serum ascites albumin gradient (SAAG) in a contemporary unselected medical cohort.

To describe the different aetiologies of ascites and test the validity of serum ascites albumin gradient (SAAG) and cytology in a contemporary unselected medical cohort. All adult patients admitted to Nottingham University Hospitals, UK, between 1 May 2013 and 30 April 2018 with new-onset radiologically-confirmed ascites were included. Data were analysed to determine the distribution of different aetiologies of ascites and the diagnostic accuracy of SAAG in portal hypertension and cytology in malignancy as underlying causes of ascites. Over 5 years, 286 patients presented with new-onset ascites; 122 surgical cases were excluded. Most patients were men (n = 84, 51.2%) over 50 years of age (n = 142, 86.6%). Cirrhosis accounted for 54.9% (n = 90) of the cases of ascites followed by malignancy (n = 48, 29.3%) and cardiac failure (n = 10, 6.1%). SAAG ≥11 g/L had a sensitivity of 85.5% and specificity of 60.6% for diagnosing portal hypertension as a cause of ascites (diagnostic accuracy = 78.5%, 95% confidence interval (CI): 69.8-85.5; area under the curve (AUC) = 0.756, 95% CI: 0.652-0.860). Ascitic fluid cytology was positive in 50% of malignant cases and 66% of primary peritoneal carcinomatosis cases. The underlying aetiology and the validity of available tests varied substantially compared with previous reports.

S3127 Peritoneal Tuberculosis in an Immunocompetent Patient With Findings of Chronic Liver Disease and Peritoneal Carcinomatosis

Introduction: Peritoneal tuberculosis (PT) accounts for 1-2% of all tuberculosis cases. Diagnosis of PT can be challenging due to non-specific symptoms, insidious onset, and variable imaging findings. We present a case of PT presenting with ascites and imaging studies suggestive of chronic liver disease (CLD), and peritoneal carcinomatosis. Case Description/Methods: A 48-year-old man presented to our clinic with complaints of increased abdominal girth, weight loss, and night sweats for the past 3 months. Physical exam revealed soft and distended abdomen with shifting dullness. Laboratory tests showed a mild anemia of Hb at 13.0 g/dL (13.1-17.2) and ESR at 34 mm/h (0-15). Abdominal ultrasound (US) revealed the presence of free abdominal fluid, and diffuse heterogenous granular liver parenchyma supporting the diagnosis of CLD. His liver tests were within normal ranges. Ascitic fluid analysis revealed serum ascites albumin gradient (SAAG) of 0.2 g/dL, WBCs of 1.70 × 103 cells/dL (91.8% lymphocytes). Ascitic fluid cytology was negative for malignant cells. Ascitic fluid acid-fast bacilli (AFB) test and mycobacterial culture were negative. Adenosine deaminase (ADA) level in ascitic fluid was 108.5 U/L (0-40). Interferon-gamma release assay (IGRA) test was positive. Contrast-enhanced computed tomography (CT) scan revealed normal liver parenchyma, diffuse thickening and nodularity of the peritoneum, and thickening of omentum with omental cake appearance. CT scan was suggestive of peritoneal carcinomatosis. EGD and colonoscopy were unremarkable. With consistent clinical history, SAAG < 1.1, ascitic fluid with lymphocytic predominance, high ADA levels, and positive IGRA, a diagnosis of PT was made. Anti-tuberculosis treatment was initiated, and the patient’s clinical symptoms have improved. CT scan at the end of treatment showed the resolution of ascites and peritoneal findings (Figure 1). Discussion: Ascites is the most common presenting symptom of PT. High suspicion of PT is important in the setting of ascites of unknown origin. Despite the US findings were suggestive of CLD in this patient, CT scan revealed normal liver findings. Differing PT from peritoneal carcinomatosis might be challenging due to overlapping findings on imaging. Ascitic fluid analysis of SAAG < 1.1, high ADA levels, positive IGRA test should lead towards the diagnosis of PT. AFB and mycobacterial culture of the ascitic fluid may often have low diagnostic yield in PT. Early diagnosis and treatment are important to prevent complications.Figure 1.: A1, A2, Before treatment; axial contrast-enhanced computed tomography scan showing moderate ascites, and diffuse thickening and nodularity of peritoneum. Imaging is suggestive of peritoneal carcinomatosis. B1, B2, After treatment; resolution of ascites and peritoneal findings.