Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension.
OBJECTIVE
We sought to determine the correlation between the level of serum-ascites albumin concentration gradient (SAAG) and the complications of portal hypertension (PHTN), manifested by the presence and grade of esophageal varices (EV).


METHODS
Our study included 31 patients with ascites, demonstrated by ultrasonography, who had measurement of the SAAG. All had upper gastrointestinal endoscopy with assessment of the presence and size of EV. High SAAG was considered to be present when the SAAG was > or = 1.1 g/dl and Low SAAG when it measured < 1.1 g/dl.


RESULTS
We found that 25 of 31 (80.6%) patients had High SAAG and six of 31 (19.4%) had Low SAAG. Esophageal varices were present in 17 of 25 (68%) patients with High SAAG and in none of six (0%) patients with Low SAAG (p = 0.028). In patients with alcoholic liver disease (ALD), 14 of 14 (100%) had EV. Otherwise, in patients with nonALD, only three of 11 (27.3%) had EV (p < 0.05). The presence of EV was associated with the Child-Pugh Score (p = 0.039). Among patients with High SAAG, EV were present in four of 10 (40%) with SAAG values of 1.10-1.49 g/dl; in four of 6 (66.7%) with SAAG values of 1.50-1.99 g/dl; and in nine of nine (100%) with SAAG values of > or =2.0 g/dl (p = 0.049). The size of the EV had no association with the level of SAAG in patients with High SAAG (p = 0.788), with a Pearson correlation coefficient of R = 0.54 (p = 0.005). Using the Receiver-Operating-Characteristic Curve a SAAG value of > or =1.435 +/- 0.015 g/dl was an accurate indicator of the presence of EV (cutoff point for the higher predictive value: positive = 87.5% and negative = 66.7%).


CONCLUSIONS
In patients with ascites the presence of EV is associated only with patients with High SAAG. The presence of EV in patients with ascites and High SAAG is directly related to the degree of SAAG. The size of the EV in patients with ascites and High SAAG is not associated with the degree of SAAG. A SAAG value of > or =1.435 +/- 0.015 g/dl is a useful means to predict the presence of EV in patients with ascites. Finally, in patients with ascites, EV were more prevalent in those with ALD.
Torres
E
E
Department of Internal Medicine, Universidad Peruana Cayetano Heredia, School of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru.
Barros
P
P
Calmet
F
F
D000293:Adolescent; D001202:Ascitic Fluid / Q000737:chemistry*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000378:metabolism; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D008108:Liver Diseases, Alcoholic / Q000378:metabolism; D012372:ROC Curve; D012709:Serum Albumin / Q000032:analysis*
D012709:Serum Albumin