Etiology of Ascites and the Diagnostic Value of Serum-Ascites Albumin Gradient in Non-Alcohol Liver Disease

Abstract

This study was designed to determine the different etiologies of ascites and the diagnostic value of serum-ascites albumin gradient (SAAG) in patients with ascites of non-alcoholic liver disease in Southern Saudi Arabia. A total of 132 patients with ascites (96 males and 36 females, mean age 58.8±15.9 years) were studied for the different causes of ascites. In 55 patients with liver disease and 22 patients with nonliver disease (malignancy and peritoneal tuberculosis), we compared SAAG with the three usual parameters of ascitic fluid biochemical analysis used in the differential diagnoses of ascites. The nonliver disease group showed higher ascitic fluid total protein (aTP) concentration (4.77±2.05 versus 1.98±1.56 g/dL), ascitic to serum ratio of total protein (a/sTP) concentration (0.75±0.43 versus 0.26±0.19), ascitic fluid lactic dehydrogenase (aLDH) level (565.4±353.4 versus 254.1±205.03 U/L) and a lower SAAG (0.6±0.30 versus 1.71±0.61). P<0.0001 for all parameters. The positive predictive values for aTP, a/sTP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76%, 67%, and 80%, respectively, while the negative predictive values were 96%, 96%, 84%, and 98%, respectively. Liver causes accounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephrotic syndrome 3.0%. SAAG is a useful diagnostic parameter which can be used to separate ascites of liver disease (nonalcoholic) from other causes of ascites, with an efficiency of 91%. SAAG should replace the traditional parameters (aTP, a/sTP, and aLDH) used in the differential diagnosis of ascites. In our series, liver disease is the major cause of ascites, followed by peritoneal tuberculosis.

Pharmacoepidemiology of ascites and associated complications in hospitalized patients: descriptive observational study

“…While the prominent cause for the exudative type of fluid was found to be chronic renal failure. These results were almost same as found in other local and Middle East study (Muhammed et al, 2012;Al Knawy, 1997).…”

“…It is the pathological accumulation of free fluid in the peritoneal cavity. The fluid accumulates because of conditions directly involving the peritoneum (infection, malignancy), or due to other diseases remote from the peritoneum (i.e., liver disease, heart failure, hypoproteinaemia) (Muhammed et al, 2012;Al Knawy, 1997).…”

Clinical Pattern of Cirrhotic Ascities in the State of Qatar

“…western countries (6 " 9) , but different from those reported in Saudi Arabia (10,12) . Surprisingly, chronic alcoholism among Qatari patients accounted for 57.7% of patients with cirrhotic ascites.…”

Pleural, peritoneal and pericardial effusions – a biochemical approach

“…Given the superiority of the SAAG concept, the replacement of the traditional transudate/exudate concept was proposed. Ascitic fluid should be classified as high-albumin gradient or low-albumin gradient depending on the SAAG value (49,53,54). Both SAAG and ascitic fluid protein concentration are recommended for the initial evaluation of ascitic fluid in cirrhosis, proposed by the American Association for the Study of Liver Disease (AASLD) and British Society of Gastroenterology (47,55).…”