• Muhammad Younas
  • Abdus Sattar
  • Rizwan Hashim
  • Aamir Ijaz
  • Muhammad Dilawar
  • Sayed Mohsin Manzoor
  • Asif Ali
  • Farooq Ahmad Khan


Background: The classification of ascites as ‘exudative’ and ‘transudative’ based on ascitic fluidtotal protein (AFTP) has been challenged in many clinical conditions like cardiac ascites, patientson prolonged diuretic therapy and malignant ascites because it had poor diagnostic efficacy. Thesedrawbacks have led to the development of another approach to classify ascites, which is based onSerum-Ascites Albumin Gradient (SAAG) to differentiate ascitic fluid into two categories: SAAG≥11 g/L in ascites due to portal hypertension and SAAG <11 g/L in ascites unrelated to portalhypertension. Objective of this study was to compare the diagnostic efficacy of serum/ascites fluidalbumin gradient and ascitic fluid total protein in patients having ascites. Methods: This Crosssectional comparative study was conducted in the Department of Chemical Pathology andEndocrinology, Armed Forces Institute of Pathology, Rawalpindi from 1st Jun 2007 to 30th May2008. Ninety-three patients were included in the study by non probability convenience sampling.The patient grouped as: (Group I) 73 cases of liver cirrhosis, (Group II) 14 cases of hepatoma and6 cases of tuberculous ascites. Ascitic fluid specimen and 3 ml blood were obtained for asciticfluid estimation of ascitic fluid albumin, total proteins and serum albumin. Diagnostic efficacy ofSAAG and AFTP was calculated by comparing the results with clinical, ultrasonographic, histopathological findings, ascitic fluid cell count/acid fast bacilli culture and other relevantinvestigations. Results: Seventy-three cases had liver cirrhosis (group I), 14 cases had hepatomaand 6 cases had tubercular ascites (group II). Age ranged 25–80 years with mean age 56 years.Diagnostic accuracy, Sensitivity, Specificity, Positive predictive value (PPV) and Negativepredictive value (NPV) of SAAG were 96%, 97%, 95%, 98.6%, and 90% respectively, whereasthose of AFTP were 56%, 53%,70%, 86%, and 29% respectively. Conclusion: Differentialdiagnosis of ascites should be based on SAAG because diagnostic efficacy of SAAG wassignificantly higher than AFTP in work-up of ascites.Keywords: Ascites, Serum/ascites albumin gradient, Ascitic fluid total protein


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