Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites
Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites
DOI:
https://doi.org/10.70284/njirm.v2i3.1916Keywords:
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
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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.
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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.
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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. https://doi.org/10.70284/njirm.v2i3.1916
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