Diagnosing ascites: value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum-ascites albumin and cholesterol gradient.
Ascitic fluid total protein, albumin, cholesterol, their ascites/serum ratios, serum-ascites albumin and cholesterol gradients were measured for their ability to differentiate cirrhotic, malignant and tuberculous ascites in 76 patients. The mean +/- s.d. ascitic fluid total protein, albumin, cholesterol, their respective ascitic fluid/serum ratios in cirrhotic ascites were lower than malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was significant for ascitic fluid/serum total protein (P < 0.05) and ascitic fluid/serum albumin (P < 0.01) only. Mean serum-ascites albumin gradient in cirrhotics was higher than in the malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was significant (P < 0.01). Mean +/- s.d. serum-ascites cholesterol gradient in cirrhotics was higher than that in malignant and tuberculous groups (P < 0.001 for each). The difference between malignant and tuberculous groups was also significant (P < 0.01). Both serum/ascitic fluid total protein less than 0.5 and ascitic fluid cholesterol less than 55 mg/dL had 94% diagnostic accuracy for differentiating cirrhotic from malignant and tuberculous differentiating cirrhotic from malignant and tuberculous ascites. Serum ascitic fluid albumin gradient greater than 1.1 g/dL, ascitic fluid/serum albumin less than 0.65 and ascitic fluid albumin less than 2 g/dL had diagnostic accuracy of 92, 92 and 91%, respectively. Ascitic fluid total protein had diagnostic accuracy of 88%. None of the tests was able to differentiate between malignant and tuberculous ascites. Measurement of ascitic fluid cholesterol concentration is a simple method of differentiating cirrhotic from non-cirrhotic ascites.
Gupta
R
R
Department of Gastroenterology and Pathology, M.L.N. Medical College, Allahabad, India.
Misra
S P
SP
Dwivedi
M
M
Misra
V
V
Kumar
S
S
Gupta
S C
SC
D000418:Albumins / Q000032:analysis; D001201:Ascites / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001202:Ascitic Fluid / Q000737:chemistry*; D001798:Blood Proteins / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000150:complications; D002784:Cholesterol / Q000032:analysis / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D017093:Liver Failure / Q000150:complications / Q000378:metabolism; D008113:Liver Neoplasms / Q000737:chemistry / Q000150:complications; D011446:Prospective Studies; D011506:Proteins / Q000032:analysis; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis
D000418:Albumins; D001798:Blood Proteins; D011506:Proteins; D012709:Serum Albumin; D002784:Cholesterol