Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites

Abstract

The serum-ascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A greater than 1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with right-sided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A greater than 1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.

Management of adult patients with ascites caused by cirrhosis†

“…12 The serum-ascites albumin gradient has been proved in prospective studies to categorize ascites better than the total-protein based exudate/transudate concept and than the modified pleural fluid exudate/trandudate criteria. [15][16][17] Calculating the serum-ascites albumin gradient involves measuring the albumin concentration of serum and ascitic fluid specimens and subtracting the ascitic fluid value from the serum value. With approximately 97% accuracy, a serum-ascites albumin gradient of H1.1 g/dL (11 g/L) indicates that the patient has portal hypertension.…”

To study the relation between spontaneous bacterial peritonitis and serum ascitis albumin gradient in chronic liver disease patients

“…A SAAG greater than 1.1, known as high-SAAG ascites, has a sensitivity of 97% in indicating portal-hypertensive ascites. 8,9 Total protein concentration is lower in spontaneously affected ascitic fluid compared to sterile fluid obtained from different patients. The opsonic activity of ascitic fluid correlate closely with the fluid's protein concentration.…”

Severe Ascites with Hypothyroidism and Elevated CA125 Concentration: A Case Report

“…Ascites is an uncommon complication in hypothyroid patients. Hypothyroidism is the cause of ascites in less than 5% of ascites cases [7], and less than 4% of hypothyroidism cases are complicated by ascites [8]. Ascites in patients with myxedema appears to be cardiac ascites, related to the subtle heart failure that these patients develop [9].…”

“…Ascites in patients with myxedema appears to be cardiac ascites, related to the subtle heart failure that these patients develop [9]. In ascites with myxedema, the ascitic fluid is high in protein and has a high SAAG [7,9]. Although ascites fluid is evaluated for both protein levels and the SAAG, the SAAG is particularly useful.…”