A study on serum ascitic fluid cholesterol gradient in differentiating cirrhotic and malignancy related ascites

Background: Ascites is defined as the collection of excessive amount of free fluid within the peritoneal cavity. For the purpose of lubrication normally at least 50 ml of free fluid is present in the peritoneal cavity. Objectives: This study was done to investigate the level of efficiency of various conventional parameters in differentiating cirrhotic ascites from malignancy related ascites and to propose serum ascites cholesterol gradient as a new diagnostic parameter. Materials and methods: This study was conducted among 100 patients of both sexes who have clinically significant ascites admitted in the wards of General medicine, Medical Gastroenterology and medical oncology in Govt. Rajaji Hospital, Madurai. Age group of 20-60 years of both sexes were included. Results: The mean (±SD) of ascitic fluid cholesterol concentration for cirrhosis group was 56.4 mg% (±7.76) and that for MRA group is 76.26 mg% (±8.27). The p value was <0.001 which was significant. The mean (±SD) of serum ascites cholesterol gradient (SACG) for cirrhosis group was 67.52 (±4.46) and that for MRA group was 60.16 (±3.38). The p value was <0.001 which was significant. The MRA group has low SACG compared to patients with cirrhosis. SACG has shown high specificity in this study which supports the findings of other similar studies. Conclusion: This study has shown that conventional parameters like ascitic fluid total protein, ascitic fluid albumin, serum ascites albumin gradient are still good at differentiating cirrhotic ascites from malignancy related ascites. SACG with a cut off level of 62.5 mg% has shown to be a better marker in terms of diagnostic accuracy to differentiate MRA from cirrhotic ascites. Thus ascitic fluid cholesterol level and SACG has been proposed as a new diagnostic marker which are more reliable and cost effective to differentiate MRA from cirrhotic ascites.