Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites.
Serum-ascites albumin concentration gradient, a parameter of oncotic pressure gradient reflecting presence or absence of portal hypertension, was compared with the usual parameters of ascitic fluid analysis in the differential diagnosis of ascites. Twenty-nine patients with liver disease and 15 patients with malignant neoplasm were prospectively studied. The group with malignant neoplasm showed higher ascitic fluid total protein level (3.70 +/- 1.28 vs. 1.66 +/- 1.20 g/dl), ascites to serum ratio of total protein level (0.58 +/- 0.14 vs. 0.26 +/- 0.14), ascitic fluid lactic dehydrogenase level (756 +/- 693 vs. 151 +/- 125 U/L), ascites to serum ratio of lactic dehydrogenase level (1.13 +/- 0.79 vs. 0.35 +/- 0.22), and lower serum-ascites albumin gradient (0.72 +/- 0.30 vs. 1.85 +/- 0.45) (p less than 0.001 for all parameters). Results of the serum-ascites albumin gradient overlapped the least between the two groups: all but 1 patient with malignant ascites while only 1 patient with liver disease had a gradient lower than 1.1. We conclude that the serum-ascites albumin gradient offers the best diagnostic discrimination between ascites caused by liver disease and ascites caused by a neoplasm.
D001201:Ascites / Q000097:blood / Q000209:etiology*; D001202:Ascitic Fluid / Q000032:analysis* / Q000166:cytology; D003937:Diagnosis, Differential; D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000209:etiology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008107:Liver Diseases / Q000097:blood / Q000150:complications*; D012709:Serum Albumin / Q000032:analysis*
D012709:Serum Albumin; D007770:L-Lactate Dehydrogenase