Diagnostic paracentesis. A two-step approach.
Diagnostic paracentesis is usually considered the first test to be performed in the assessment of the ascitic patient and a large number of investigations on ascitic fluid have been proposed. To assess the value of a simplified procedure, serum to ascites albumin gradient and ascitic white blood cell counts were employed as a first step. One hundred and fifty-three paired serum and ascitic fluid samples were analysed and allowed patients to be divided into three groups: 1) serum to ascites albumin gradient > = 11 g/L and white blood cells < 0.5 x 10(9)/L predicted cirrhosis (or liver carcinoma) without peritonitis with 83% efficacy, 96% positive predictive value and 65% negative predictive value; 2) serum to ascites albumin gradient > = 11 g/L and white blood cells > = 0.5 x 10(9)/L predicted cirrhosis (or liver carcinoma) with peritonitis with 86% efficacy, 45% positive predictive value and 99% negative predictive value; 3) serum to ascites albumin gradient < 11 g/L predicted the other diagnoses with 92% efficacy, 77% positive predictive value and 95% negative predictive value. As serum to ascites albumin gradient > = 11 g/L and white blood cells < 0.5 x 10(9)/L predicted cirrhosis (or liver carcinoma) without peritonitis in 96% of the cases and excluded peritonitis in 99% of the cases, further fluid ascitic analyses could be considered as a second step only in patients with serum to ascites albumin gradient < 11 g/L and/or white blood cells > = 0.5 x 10(9)/L. In a group of ascitic patients where the prevailing diagnosis is cirrhosis (or liver carcinoma) without peritonitis, this simplified approach could provide a favourable cost/benefit ratio.
Sartori
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M
Dipartimento di Scienze Biomediche ed Oncologia Umana dell'Università di Novara, Italy.
Andorno
S
S
Gambaro
M
M
Leone
F
F
Molinari
G L
GL
Pontiroli
L
L
Aglietta
M
M
D000368:Aged; D000418:Albumins / Q000032:analysis; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology; D001202:Ascitic Fluid / Q000737:chemistry* / Q000166:cytology*; D016022:Case-Control Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000150:complications; D010538:Peritonitis / Q000150:complications; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis
D000418:Albumins; D012709:Serum Albumin