Significance of Serum and Ascitic Fluid C-Reactive Protein in Differential Diagnosis of Benign and Malignant Ascites

Yüksel, İlhami; Karaahmet, Fatih; Coşkun, Yusuf; Kılınçalp, Serta; Hamamci, Mevlut; Akıncı, Hakan; Üstün, Yusuf; Simsek, Zahide; Erarslan, Elife

doi:10.1007/s10620-014-3205-4

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…The high levels of C-reactive protein and insulin-like growth factor-1 in ascitic fluid make it possible to suspect malignant ascites[28], and a cholesterol level of more than 45 mg/100 mL in combination with cytology and carcinoembryonic antigen determination have diagnostic value[29]. Malignant ascites can also be assumed if there is a high level of C-reactive protein both in ascitic fluid and blood serum[30].…”

Section: Ascitic Fluid Analysismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords: “liver cirrhosis,” “portal hypertension,” “ascites,” “pathogenesis,” “diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

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Section: Ascitic Fluid Analysismentioning

confidence: 99%

Current approaches to the management of patients with cirrhotic ascites

Garbuzenko¹,

Arefyev²

2019

WJG

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“…At a cut-off value of 7.3 ng/ml, serum CRP levels had specificity of 77.3% and sensitivity of 84.7% for detecting malignant ascites respectively. Similarly, Yuskel et al, 19 also showed that mean baseline serum and ascites levels of CRP were significantly higher in Group 2 (low gradient ascites) compared to those in Group 1(high gradient ascites) (p = 0.021, p = <0.0001, respectively).…”

Section: Discussionmentioning

confidence: 70%

To Study the Usefulness of Serum and Ascitic Fluid C-Reactive Protein (Crp) and Ascitic Fluid Cholesterol Level in Differential Diagnosis of Malignant, Nonmalignant and Tubercular Ascites

Mayank¹,

Priyadarshi²,

Singh³

et al. 2018

jemds

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BACKGROUND Ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant and tubercular causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown aetiology. Therefore, this study was planned to evaluate usefulness of serum & ascitic fluid C-Reactive Protein (CRP), SAAG and ascitic fluid cholesterol level in diagnosis of malignant, non-malignant and tubercular ascites. MATERIALS AND METHODSWe conducted a prospective observational study in 80 patients, those admitted and willing to give consent in the department of Medicine, LLR & Associated Hospitals, GSVM Medical College, Kanpur from December 2015 to October 2017. All patients underwent full investigations to make the diagnosis of ascites malignant (20) and nonmalignant (n=54)), tubercular (7) and nontubercular (47) groups. 6 patients were excluded because the ascitic fluid analysis was suggestive of bacterial peritonitis. The data was processed in MS Excel and analysis was carried out using SPSS Ver. 23. RESULTSWe found that in the non-malignant group mean value of ascitic fluid CRP was 0.29+0.12 vs 3.16+1.42 (mg/l) in malignant group, SAAG was 1.81+0.70 vs 0.87+0.34 (mg/l) in non-malignant vs malignant group. The mean value of ascitic fluid cholesterol in malignant group was 100.85 + 34.28 vs 6.7 + 2.5 in non-malignant group (p value <0.01) and the mean value of ascitic fluid cholesterol in malignant group was 100.80 + 34.28 vs 32.43 + 15.7 in tubercular group, so ascitic fluid cholesterol is highly specific (100%) and sensitive (65%) at cut off value of 100 mg/dl in differentiating benign and malignant causes of ascites. CONCLUSION SAAG, Ascitic fluid CRP, and cholesterol having high specificity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.

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“…There was a notable difference between pleural and ascitic effusions in group B, the prevalence of malignant effusions in pleural (20, 23) described previously was lower than we found in the present study for peritoneal effusions, since ascitic effusions were more likely to be malignant. Higher concentrations of CRP have been described in peritonitis (15,16) but also in malignant ascites (25,26). Some ovarian, pancreatic and colonic cancer may have an important inflammatory component.…”

Section: Discussionmentioning

confidence: 99%

Comparative Assessment of Two Strategies for Interpreting Tumor Markers in Ascitic Effusions

Trapé

Sant

Montesinos

et al. 2020

In Vivo

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Background/Aim: There are two strategies for the interpretation of tumor markers (TM) in fluid effusions: i) high cutoff and ii) fluid/serum ratio (F/S) and low cutoff. The objective of this study is to compare these two strategies and to determine whether diagnostic accuracy improves by the identification of possible false positives using Adenosine deaminase (ADA), C reactive protein (CRP) and % of polymorphonuclear cells (%PN). Patients and Methods: We studied 157 ascitic fluids, 74 of which were malignant. ADA, CRP and %PN were determined in ascitic fluid, and Carcinoembryonic antigen (CEA), Cancer antigen 72-4 (CA72-4), Cancer antigen CA19-9 and Cancer antigen 15-3 (CA15-3) in both fluid and serum. Results: The strategy of high cutoff showed 59.5% sensitivity at 100% specificity. The F/S strategy showed 75.7% sensitivity at 95.2% specificity. Subclassifying cases with ADA, CRP and %PN negative showed 67.5% sensitivity at 100% specificity for high cutoff and for the F/S strategy was 81.7% sensitivity at 98.7% specificity. Conclusion: The strategy of F/S with negative ADA, CRP and %PN allow the best interpretation for TM in the ascitic fluid. Ascites is the abnormal accumulation of fluid in the peritoneal cavity. It is mostly seen in patients with liver disease, pancreatic disease, tuberculous peritonitis, congestive heart failure, kidney disease, acquired immune deficiency syndrome and cancer (1). Cytology is the gold standard for confirming the presence of malignant cells in ascitic fluid, but its sensitivity only ranges between 50 and 70% (2). The main cause of this low sensitivity is the fact that a primary tumor may infiltrate the peritoneum but may not shed cells, with a negative result in the cytological analysis. In these cases, other invasive procedures, such as laparoscopy may be needed to confirm the presence of malignant cells. The potential of tumor markers (TM) for improving the diagnosis of malignant pleural and peritoneal effusions has been mentioned by several authors but there are major discrepancies between the reports regarding their specificity and sensitivity, and also in terms of the cutoff values used (3-5): for Carcinoembryonic antigen (CEA) the range is 2-50 ng/ml and for Cancer antigen 19-9 (CA19-9) it is 14.5-200 ku/l (6-10). Their sensitivity ranges between 24% and 77% and their specificity from 82% to 100% (6-10).

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Significance of Serum and Ascitic Fluid C-Reactive Protein in Differential Diagnosis of Benign and Malignant Ascites

Abstract: Increased levels of serum and ascitic fluid CRP were associated with malignant ascites.

Cited by 9 publications

References 16 publications

Current approaches to the management of patients with cirrhotic ascites

Current approaches to the management of patients with cirrhotic ascites

To Study the Usefulness of Serum and Ascitic Fluid C-Reactive Protein (Crp) and Ascitic Fluid Cholesterol Level in Differential Diagnosis of Malignant, Nonmalignant and Tubercular Ascites

Comparative Assessment of Two Strategies for Interpreting Tumor Markers in Ascitic Effusions

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