American Journal of Medical and Clinical Sciences. 2018; 3(2):(28-74)


Differentiating malignancy-related ascites from cirrhotic ascites: Diagnostic significance of serum and ascitic fluid cholesterol, albumin, protein, fibronectin serum ascites albumin gradient (SAAG), serum ascites cholesterol gradient (SACG)

Lawson Ekpe

Abstract

Background: Over the years, differential diagnosis of ascitic fluid has been a dilemma for practicing physicians. Many analytes have been assessed to enhance diagnosis in this regard. In developing countries, the emphasis is laid on using less expensive biochemical parameters and methods to differentiate ascitic fluid. The aim of the present study was to assess the value of ascitic fluid cholesterol, albumin, protein, and their gradients [serum ascites albumin gradient (SAAG) and serum ascites cholesterol gradient (SACG)] in differentiating malignant and cirrhotic ascites. 

Materials and Methods: This cross-sectional prospective study was carried out over a 2-year period at the medical, surgical, emergency, and gynecology units of the Lagos University Teaching Hospital. A total of 61 adult patients with ascites (35 males, 26 females) were recruited for the study. Serum and ascitic fluid were assessed for levels of cholesterol, protein and albumin and their gradients. 

Results: Of the total 61 adult patients recruited (35 males, 26 females), the mean age of the study population was 46.84 ± 12.10, mean body mass index was 24.43 ± 3.18. Serum and ascitic values of cholesterol, protein, and albumin were 125.1 ± 79.30, 72.29 ± 6.65, and 39.51 ± 7.98 mg/dl, with corresponding p values of p = 0.0475, p = 0, and p = 0.072. The accuracy of serum cholesterol, protein, and albumin was 81.99%, 37%, and 60.6% when compared to ascitic cholesterol, protein, and albumin (58.9%, 70.5%, and 67.2%). Serum protein had a sensitivity of 94.3% while ascitic cholesterol had a sensitivity of 51.4%. Mean SACG and SAAG were 89.84 ± 79.89 and 11.48 ± 8.7, respectively. 

Conclusion: Differentiation of cirrhotic and malignancy-related ascites seem to have very little diagnostic values from analytes of cholesterol, albumin, and protein.

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