Other
investigators have found that in
adults the
Serum-
Ascites Albumin Gradient (SAAG) to be 1.1 g/dl or greater in the presence of
portal hypertension (PTHN) and less than that in its absence. We sought to determine the correlation between the level of SAAG and the
complications of PTHN, manifested by the presence of esophageal
varices in
children with
ascites. Our study included 26
patients with
cirrhosis, diagnosed by
liver biopsy and 14
patients with
nephrotic syndrome (NS) diagnosed by established criteria. The SAAG was measured in all
patients. The
patients with
cirrhosis had upper gastrointestinal (GI)
endoscopy for assessment of esophageal
varices (EV). We found that 84.6% (22 of 26)
patients with
cirrhosis had High SAAG (> or = 1.1 g/dl) and 15.4% (4 of 26) had low SAAG (< 1.1 g/dl) (p < 0.001). EV was found in 91% (20 of 22)
patients with high SAAG and in 50% (2 of 4)
patients with low SAAG (p = 0.013). The SAAG differentiated
cirrhosis with EV from those without EV (
sensitivity = 91%,
specificity = 50%,
positive predictive value = 91%,
negative predictive value = 50% and
efficacy = 85%). The high SAAG is a useful means to predict the presence of EV in
children with
ascites.