Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites
Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites
Keywords:
Cirrhosis, Ascitic fluid cholesterol, Tuberculous peritonitis, Malignant ascitesAbstract
Background: Differential diagnosis of ascites is a common clinical problem. Less expensive biochemical techniques are required to differentiate ascites with unknown etiology. Aim: To evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradients (SACG) in differentiating cirrhotic, tuberculous and malignant ascites. Methods: 50 patients (25 with hepatic cirrhosis, 15 with tuberculosis and10 with malignancy) were evaluated for ascitic fluid total protein, albumin, cholesterol, SAAG and SACG. Results: The mean ascitic fluid cholesterol was significantly higher in malignant ascites when compared with cirrhosis and tuberculous ascites (p= 0.0001 each). The difference between tuberculous and cirrhotic ascites was also significant (p= 0.001). The mean value of SAAG was significantly higher in cirrhosis when compared with tuberculous and malignant ascites (p= 0.0001; p= 0.001 respectively) but the difference between tuberculous and malignant ascites was not significant The mean SACG was significantly lower in malignant compared to tuberculous and cirrhotic ascites (p= 0.0001; p= 0.001 respectively). The difference between tuberculous and cirrhotic ascites was not significant. Conclusion: SAAG is a better marker to differentiate cirrhotic ascites from tuberculous and malignant ascites. Ascitic fluid cholesterol and SACG are better markers to differentiate malignant ascites from cirrhotic and tuberculous ascites.
References
1. Runyon BA. Management of adult patients with ascites due to cirrhosis. AASLD Practice Guideline. Hepatology 2004; 39:1-16.
2. Moore KP, Aithal GP. Guidelines on management of ascites in cirrhosis .Gut 2006; 55 (Suppl.VI):vi1-12.
3. Pare P, Talbot J, Hoefs JC. Serum ascites albumin gradient-A physiological approach to differential diagnosis of ascites. Gastroenterol 1983; 85 (2): 240- 4.
4. Paddock F. The diagnostic significance of serous fluids in Disease. New England Journal of Medicine 1940; 223: 1010.
5. Pare P, Talbot J, Hoefs JC. Serum ascites albumin gradient- A physiological approach to differential diagnosis of ascites. Gastroenterology 1983; 85(2):240-4
6. Madan M Singh, AmarN Bhargava, Kranthi P Jain. Tuberculous Peritonitis. New England Journal of medicine 1969; 281(20):1091-4
7. SoodA, GargR, KumarR etal. Ascitic fluid cholesterol in malignant and tubercular ascites. Journal of Association of Physicians of India 1995; 43(ii):745-7.
8. Sampliner R, Iber F. High protein ascites in patients with uncomplicated hepaticcirrhosis. American journal of medical science 1974:267:275-9.
9. Jungst D, Gerbes AL, Martin R,etal. Value of lipids in differentiation between cirrhosis and malignant ascites. Hepatology1986; 6: 239-43.
10. Jungst D, Xei Y, GerbesAL etal.. Pathophysiology of elevated ascites fluid cholesterol in malignant ascites. Journal of Hepatology1992; 14(2-3):244-8.
11. Garg R, Sood A, Arora S etal. Ascitic fluid cholesterol in differential diagnosis of ascites. Journal of Association of Physicians of India 1993; 41(10):644-6.
12. Castaldo G, Oriani G, CiminoL etal. Total discrimination of peritoneal malignant ascites from cirrhosis- and hepatocellular carcinoma- associated ascites by assays of asceticcholesterol and lactate dehydrogenase. Clinical chemistry 1994; 40(3):478-83.
13. Dwivedi M, Misra SP, Misra V. Value of adenosine deaminase estimation in the diagnosis of tuberculous peritonitis. American Journal of Gastroenterology1990; 9:1123-5.
14. Polack M, DE Costa ACT, Bitelmann B. Diagnostic value of Biochemical profile(Protein, cholesterol, glucose, mucoprotein, amylase) of ascetic fliud.Rev Hosp clin Fac Med S Paulo 1978;33;186-99
15. Rector WG, Reynolds TB . Superiority of serum ascites albumin difference over the ascites total protein concentration in separation of transudative and exudative ascites. Am J Med1984; 77:83-5.
16. Rector WG. An improved diagnostic approach to ascites. Arch Intern Med 1987; 147: 215.
17. Rana SV, Babu SGV etal. Usefulness of ascetic fluid cholesterol as a marker for malignant ascites. Med SciMon 2005; 11:136-42.
18. Prieto M, Gomez-Lechon MJ, Hoyos M, etal. Diagnosis of Malignant ascites. Comparison of ascitic fibrinonectin, cholesterol, and serum-ascites albumin difference. Dig Dis Sci 1988; 33:833-38.
19. Sharath Chandra LK, Mingsen T, SinghYI etal. Serum ascites lipid gradients in alcoholic liver cirrhosis, tuberculosis and malignancy. JIACM 2005; 6:106-09.
20. Ranjith D, Ranjith MP, Debesh dutta etal. Ascitic fluid lipid profile and albumin level. Bangladesh medical research council Bulletin 2010; 1(36):34-6.
21. Procedures for the collection of diagnostic blood specimens by venipuncture: Approved standard. 4th ed. Wayne PA: National committee for Clinical Laboratory Standards, 1998.
22. Procedures for handling and transport of domestic diagnostic specimens and etiologic agents: Approved standard. 3rd ed. Wayne PA: National committee for Clinical Laboratory Standards, 1994.
23. Hoefs JC. Diagnostic Paracentesis: a potent clinical tool. Gastroenterology1990; 98:230-6.
24. Runyon BA. Paracentesis of ascitic fluid: a safe procedure. Arch Intern Med 1986; 146:2259-61.
25. Romney R, Mathurin P, Ganne-Carrie N, etal. Usefulness of routine analysis of ascitic fluid at the time of therapeutic paracentesis in asymptomatic out patients. Results of multicenter prospective study. Gasterol ClinBiol 2005; 29:275-9.
26. Silverman LM, Christenson RH. Amino acids and proteins. In: Carl A.Burtis, Edward R. Ashwood. Tietz Textbook of Clinical Chemistry, 2nd edition. Philadelphia: Saunders 1993: p696-8.
27. Doumas BT, Watson W, Biggs HG. Albumin standards and measurement of serum albumin with Bromocresol green Clin. Chem. Acta1971Jan; 31: 86-96.
28. Carl A Burtis, Edward R, Ashwood, David E, Bruns. Lipid, Apo lipoproteins and other Cardiovascular Risk factors. In: Teitz textbook of clinical chemistry 4th edition. . Philadelphia: Saunders; 26; p 942-43.
29. Zweig MH, Cambell.G. Receiver operating characteristics (ROC). Afundamental evaluation tool in clinical medicine. ClinChem1993; 39:561-77
30. A Indrayan, L Satyanarayana. Simple Biostatistics. Delhi. Academic publishers, 2003;47-63
31. Gupta R, Mishra SP, Dwivedi M,etal. Diagnosing ascites: Value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum ascites albumin and cholesterol gradient. J Gasterol and Hepatol 1995; 10:295-9
32. Runyon BA, Montano AA, Akriviadis EA, etal. The serum-ascites albumin gradient is superior to exudates-transudate concept in differential diagnosis of ascites. Ann Intern Med 1992; 117:215-20.
33. Hoefs JC. Serum protein concentration and portal pressure determine the ascitic fluid protein concentration in patients with chronic liver disease. J Lab Clin Med 1983; 102:260–73.
34. Mortensen PB, Kristensen SD, Bloch A,etal. Diagnostic value of ascitic fluid cholesterol levels in the prediction of Malignancy. Scand J Gastroentrol 1988; 23:1085–8.
2. Moore KP, Aithal GP. Guidelines on management of ascites in cirrhosis .Gut 2006; 55 (Suppl.VI):vi1-12.
3. Pare P, Talbot J, Hoefs JC. Serum ascites albumin gradient-A physiological approach to differential diagnosis of ascites. Gastroenterol 1983; 85 (2): 240- 4.
4. Paddock F. The diagnostic significance of serous fluids in Disease. New England Journal of Medicine 1940; 223: 1010.
5. Pare P, Talbot J, Hoefs JC. Serum ascites albumin gradient- A physiological approach to differential diagnosis of ascites. Gastroenterology 1983; 85(2):240-4
6. Madan M Singh, AmarN Bhargava, Kranthi P Jain. Tuberculous Peritonitis. New England Journal of medicine 1969; 281(20):1091-4
7. SoodA, GargR, KumarR etal. Ascitic fluid cholesterol in malignant and tubercular ascites. Journal of Association of Physicians of India 1995; 43(ii):745-7.
8. Sampliner R, Iber F. High protein ascites in patients with uncomplicated hepaticcirrhosis. American journal of medical science 1974:267:275-9.
9. Jungst D, Gerbes AL, Martin R,etal. Value of lipids in differentiation between cirrhosis and malignant ascites. Hepatology1986; 6: 239-43.
10. Jungst D, Xei Y, GerbesAL etal.. Pathophysiology of elevated ascites fluid cholesterol in malignant ascites. Journal of Hepatology1992; 14(2-3):244-8.
11. Garg R, Sood A, Arora S etal. Ascitic fluid cholesterol in differential diagnosis of ascites. Journal of Association of Physicians of India 1993; 41(10):644-6.
12. Castaldo G, Oriani G, CiminoL etal. Total discrimination of peritoneal malignant ascites from cirrhosis- and hepatocellular carcinoma- associated ascites by assays of asceticcholesterol and lactate dehydrogenase. Clinical chemistry 1994; 40(3):478-83.
13. Dwivedi M, Misra SP, Misra V. Value of adenosine deaminase estimation in the diagnosis of tuberculous peritonitis. American Journal of Gastroenterology1990; 9:1123-5.
14. Polack M, DE Costa ACT, Bitelmann B. Diagnostic value of Biochemical profile(Protein, cholesterol, glucose, mucoprotein, amylase) of ascetic fliud.Rev Hosp clin Fac Med S Paulo 1978;33;186-99
15. Rector WG, Reynolds TB . Superiority of serum ascites albumin difference over the ascites total protein concentration in separation of transudative and exudative ascites. Am J Med1984; 77:83-5.
16. Rector WG. An improved diagnostic approach to ascites. Arch Intern Med 1987; 147: 215.
17. Rana SV, Babu SGV etal. Usefulness of ascetic fluid cholesterol as a marker for malignant ascites. Med SciMon 2005; 11:136-42.
18. Prieto M, Gomez-Lechon MJ, Hoyos M, etal. Diagnosis of Malignant ascites. Comparison of ascitic fibrinonectin, cholesterol, and serum-ascites albumin difference. Dig Dis Sci 1988; 33:833-38.
19. Sharath Chandra LK, Mingsen T, SinghYI etal. Serum ascites lipid gradients in alcoholic liver cirrhosis, tuberculosis and malignancy. JIACM 2005; 6:106-09.
20. Ranjith D, Ranjith MP, Debesh dutta etal. Ascitic fluid lipid profile and albumin level. Bangladesh medical research council Bulletin 2010; 1(36):34-6.
21. Procedures for the collection of diagnostic blood specimens by venipuncture: Approved standard. 4th ed. Wayne PA: National committee for Clinical Laboratory Standards, 1998.
22. Procedures for handling and transport of domestic diagnostic specimens and etiologic agents: Approved standard. 3rd ed. Wayne PA: National committee for Clinical Laboratory Standards, 1994.
23. Hoefs JC. Diagnostic Paracentesis: a potent clinical tool. Gastroenterology1990; 98:230-6.
24. Runyon BA. Paracentesis of ascitic fluid: a safe procedure. Arch Intern Med 1986; 146:2259-61.
25. Romney R, Mathurin P, Ganne-Carrie N, etal. Usefulness of routine analysis of ascitic fluid at the time of therapeutic paracentesis in asymptomatic out patients. Results of multicenter prospective study. Gasterol ClinBiol 2005; 29:275-9.
26. Silverman LM, Christenson RH. Amino acids and proteins. In: Carl A.Burtis, Edward R. Ashwood. Tietz Textbook of Clinical Chemistry, 2nd edition. Philadelphia: Saunders 1993: p696-8.
27. Doumas BT, Watson W, Biggs HG. Albumin standards and measurement of serum albumin with Bromocresol green Clin. Chem. Acta1971Jan; 31: 86-96.
28. Carl A Burtis, Edward R, Ashwood, David E, Bruns. Lipid, Apo lipoproteins and other Cardiovascular Risk factors. In: Teitz textbook of clinical chemistry 4th edition. . Philadelphia: Saunders; 26; p 942-43.
29. Zweig MH, Cambell.G. Receiver operating characteristics (ROC). Afundamental evaluation tool in clinical medicine. ClinChem1993; 39:561-77
30. A Indrayan, L Satyanarayana. Simple Biostatistics. Delhi. Academic publishers, 2003;47-63
31. Gupta R, Mishra SP, Dwivedi M,etal. Diagnosing ascites: Value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum ascites albumin and cholesterol gradient. J Gasterol and Hepatol 1995; 10:295-9
32. Runyon BA, Montano AA, Akriviadis EA, etal. The serum-ascites albumin gradient is superior to exudates-transudate concept in differential diagnosis of ascites. Ann Intern Med 1992; 117:215-20.
33. Hoefs JC. Serum protein concentration and portal pressure determine the ascitic fluid protein concentration in patients with chronic liver disease. J Lab Clin Med 1983; 102:260–73.
34. Mortensen PB, Kristensen SD, Bloch A,etal. Diagnostic value of ascitic fluid cholesterol levels in the prediction of Malignancy. Scand J Gastroentrol 1988; 23:1085–8.
Downloads
Published
2011-09-30
How to Cite
Vyakaranam, S., Nori, S., M, G. S., Vyakaranam, S. B., & Bhongir, A. V. (2011). Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites: Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites. National Journal of Integrated Research in Medicine, 2(3), 22–28. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/1916
Issue
Section
Original Articles
