Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

ABSTRACT

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups Group I included 20 patients with cirrhotic ascites. Group II included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication