Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites

Bijoor, Anita R.; Venkatesh, Talavara

doi:10.1007/bf02867577

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…Almost similar result was also reported by Anita R. Bijoor et al 13 studied the ascitic fluid and serum concentration of total cholesterol, total proteins and albumin in a group of 45 patients. Non-malignant ascites patients had ascitic fluid cholesterol values of 19.41±8.33 mg/dl, as against the malignancy related ascites patients, who showed levels of 95.87±1.24 mg/dl.…”

Section: Discussionsupporting

confidence: 86%

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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Section: Discussionsupporting

confidence: 86%

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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“…Also the cut-off values obtained in the present study for ascitic fluid lipids and protein were not similar to previous studies [16, 17, 21], whereas the cut-off value for SAAG was reliable, as confirmed by previous studies [18–20, 27].…”

Section: Discussionsupporting

confidence: 59%

“…Some of recent studies had showed higher diagnostic significance of Ascitic Fluid Cholesterol and Serum Ascites Cholesterol Gradient in ascites due to malignancy [14–17]. The present study was done to reveal the diagnostic utility of serum ascites lipid gradients in patients with ascites and compared it with standard SAAG criteria, to know whether it has a higher diagnostic yield.…”

Section: Introductionmentioning

confidence: 94%

Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

Prabhu

Gangula

Stanley

2019

International Journal of Hepatology

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Context. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. Aims. To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material. The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis. Statistical Analysis Used. ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).

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“…[1] Several studies have proved an elevated ascitic fluid cholesterol levels in patients with malignant ascites but not in tuberculous ascites. [2] Along with it, serum ascites cholesterol gradient (SACG) too aids in differential diagnosis of ascites. [3,4] However only a few studies have related the serum & ascitic fluid -total protein, albumin, cholesterol & their gradients (SAAG, SACG) in differential diagnosis of ascites Hence we took up this study with primary objective to differentiate ascites due to hepatic cirrhosis and tuberculosis peritonitis by estimating Serum & Ascitic fluid -Total protein, Albumin, Cholesterol & their gradients (SAAG, SACG).…”

Section: Introductionmentioning

confidence: 99%

Usefulness of serum ascites cholesterol gradient (SACG), total protein (TP) ratio and serum ascites albumin gradient (SAAG) in differentiating tuberculous ascites and cirrhotic ascites

Dharwadkar¹,

Bijoor²

2013

Int J Med Sci Public Health

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Background: Differential diagnosis of ascites is a common clinical problem and is usually done by Serum Ascites Albumin Gradient (SAAG).However many other markers can also be utilized for the same. Aims & Objective: This study was carried out to evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) , Total protein Ratio and serum ascites cholesterol gradient (Chol gradient/ SACG) in differentiating cirrhotic and tuberculous ascites. Material and Methods: The study included 48 patients admitted in St John's Medical Hospital, Bangalore, out of which 25 patients were diagnosed with tuberculous ascites and 23 patients were diagnosed with cirrhotic ascites. Serum and ascitic fluid (AF) albumin, Total protein (TP) and Cholesterol (Chol) were estimated. The SAAG, TP ratio, Serum ascites cholesterol gradient (SACG) were calculated. Significance was assessed at 5% level of significance. Cohen's d effect size has been computed and discrimination function analysis is done to determine the percentage of correct classification between cirrhotic and tubercular ascites. Results: SAAG showed a sensitivity and specificity of 100% and 95.6% at cut off of >1.1g/dl TP ratio at a cut off > 0.5 showed sensitivity100% and specificity98% specificity. Ascitic fluid Cholesterol is high in the tuberculous group and showed sensitivity and specificity of at a cut off value of 100% and 95.5%. Ascitic fluid TP showed a sensitivity and specificity of 100% and 96% at a cut off value of <2.5g/dl. Whereas SACG at a cut off value of <95mg% showed a sensitivity and specificity of 68% and 100 % respectively. Their effect sizes were (3.18, 4.21, 3.21, 3.51, 1.00 respectively). Their % discriminations were (100%, 97.9%, 95.8%, 97.9%, 60.4%). Conclusion: We conclude that SAAG is definitely the best marker along with TP ratio and AF cholesterol. However SACG is not a good marker to differentiate tuberculous ascites and cirrhotic ascites.

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Value of ascitic fluid cholesterol and serum-ascites albumin gradient in differentiating cirrhotic and malignancy related ascites

Cited by 8 publications

References 6 publications

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

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

Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

Usefulness of serum ascites cholesterol gradient (SACG), total protein (TP) ratio and serum ascites albumin gradient (SAAG) in differentiating tuberculous ascites and cirrhotic ascites

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