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Ascites is defined as an excess of fluid within the peritoneal cavity. Causes of ascites may be classified into two pathophysiologic categories: associated with the normal peritoneum and occur due to a diseased peritoneum. Ascites is clinically apparent when the patient presents either symptomatically with abdominal distension, thus leading to further testing, or asymptomatically when radiological imaging shows unexpected peritoneal fluid accumulation. The serum ascites-albumin gradient (SAAG) and total protein levels from ascitic fluid are useful to distinguish the etiology of ascites.We report a case of a 30-years-old man with shortness of breath, the stomach has been getting bigger, nausea, and cough which was subsequently diagnosed with cirrhosis-related ascites accompanied with right heart failure and pulmonary tuberculosis.
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Background: The traditional method of classification of ascites by AFTP offers little insight into the pathophysiology of ascites formation and it has many drawbacks. In order to overcome it, the classification of ascites based on SAAG has emerged. Even SAAG has some draw backs like non correlation with ascites due to non-alcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. This study is conducted to compare the diagnostic accuracies of SAAG and AFTP in identifying the pathophysiology of ascites.Methods: A total of fifty patients who were admitted with ascites were included in the study. Ascitic fluid total protein and SAAG were calculated. They were classified on the basis of SAAG into High SAAG and Low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures, the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated sepereately. The diagnostic accuracies of SAAG and AFTP were compared statistically.Results: The sensitivity of SAAG was found to be 86.84% and that of AFTP 60%. The specificity of SAAG was found to be 83.33% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG was found to be 86% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG and AFTP for individual etiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.Conclusions: The sensitivity and specificity of SAAG was superior to AFTP in identifying the etiology of ascites.
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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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ObjectiveTo study the relationship between serum-asicites albumin gradient(SAAG) and the portal hypertensive ascites in order to appreciate the value of SAAG on the prediction of esophageal-gastric fundus variceal bleeding.Methods34 patients with cirrhotic ascites were examined with endoscopy.The patients were classified as high-gradient group and low-gradient group by the SAAG value of 11g/L.The relationship between SAAG and esophageal-gastric fundus varices was studied by Pearson correlation analyasis.Among the 34 patients studied,10 patients had esophageal-gastric fundus variceal bleeding and 24 patients had no esophageal-gastric fundus variceal bleeding.ResultsIn the 30 patients classified as high-gradient group,22 patients had esophageal-gastric fundus variceas.In the 4 patients classified as low-gradient group,no patient had esophageal-gastric fundus variceas.The results showed the direct correlation between the level of SAAG and the degree of esophageal-gastric fundus variceas ( r =0.81,P ＜0.01 ).The mean level of SAAG in bleeding group,consisting 10 patients,was (24.18 ±7.36) g/L.The mean level of SAAG in non-bleeding group,consisting 24 patients,was ( 18.19 ± 6.18)g/L.The results showed sig nificant difference between the bleeding group and non-bleeding group(P ＜0.05).ConclusionThere is correlation between the level of SAAG and the portal venous pressure.The level of SAAG is valueable on the prediction of esophageal-gastric fundus variceal bleeding.
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BACKGROUND: The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). METHODS: In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. RESULTS: Mean SAAG of HA was >1.1(1.49+/-0.40) gm/dL, and mean concentration of total protein of HA was >2.5(4.26+/-0.58) gm/dL. The mean of weekly Kt/Vurea of patients with HA(2.61+/-0.85) was significantly lower than that of patients without HA(3.48+/-0.90)(p<0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p<0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p<0.05). CONCLUSION: It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.