Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease

ABSTRACT

This study was designed to determine the different etiologies of ascites and the diagnostic value of serum-ascites albumin gradient [SAAG] in patients with ascites of non-alcohlic liver disease in Southern Saudi Arabia. A total of 132 patients with ascites [96 males and 36 females, mean age 58.8 +/- 15.9 years] were studied for the different causes of acites. In 55 patients with liver disease and 22 patients with nonliver disease [malignancy and peritoneal tuberculosis], we compared SAAG with the three usual parameters of ascetic fluid biochemical analysis used in the differential diagnoses of ascites. The nonliver disease group showed higher ascetic fluid total protein [aTP] concentration [4.77 +/- 2.05 versus 1.98 +/- 1.56 g/dL], ascetic to serum ratio of total protein [a/sTP] concentration [0.75 +/- 0.43 versus 0.26 +/- 0.19], ascetic fluid lactic dehydrogenase [aLDH] level [565.4 +/- 353.4 versus 254.1 +/- 205.03 U/L] and a lower SAAG [0.6 +/- 0.30] versus 1.71 +/- 0.61]. P< 0.0001] for all parameters. The positive predictive values for aTP, a/sTP, a/s TP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76, 76%, and 80%, respectively, while the negative predictive values were 96%, 96%, 84%, and 98%, respectively. Liver causes accounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephritic syndrome 3.0%. ASSG is a useful diagnostic parameter which can be used to separate ascites of liver disease [nonalcoholic] from other causes of acites, with an efficiency of 91%. SAAG should replace the traditional parameters [aTP, a/sTP and aLDH] used in the differential diagnosis of ascites. In our series, liver disease is the major cause of ascites, followed by peritoneal tuberculosis