Clinical Study of Ascites with Special Reference to Serum Ascites Albumin Gradient and Serum Ascites Cholesterol Gradient

Background: Ascites being a common clinical problem with a vast spectrum of etiologies, biochemical parameters are required to differentiate ascites which can correlate with pathogenesis. Aims of the study were to determine the sensitivity, specificity and diagnostic efficacy of serum ascites albumin Gradient (SAAG) and that of ascitic fluid total protein (AFTP), evaluating their diagnostic role in identifying the etiology of ascites, to determine the diagnostic efficacy of Ascitic fluid cholesterol and serum ascites cholesterol gradient (SACG) in diagnosis of malignant ascites. Methods: In this study, 50 patients of ascites were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG along with ultrasound. Results: Sensitivity, Specificity, and Diagnostic accuracy of SAAG for Portal hypertension were 95.5 %, 100 %, 96 % respectively, whereas those of AFTP for exudative/transudative ascitis were 100 %, 75 %, 78 % respectively. Similarly with a cut off level of 70mg % and 54 mg %, ascitic fluid cholesterol and SACG are having diagnostic accuracy of 96 % and 98 % respectively. Conclusions: SAAG is much more superior to AFTP in differential diagnosis of Ascitis. Ascitic fluid cholesterol and SACG are simple and cost effective methods to separate malignant ascitis from non-malignant causes even in small centres with limited diagnostic facilities.