Low gradient ascites: a seven-year course review.
OBJECTIVE
To study the patients with low gradient ascites in hospitals of Guilan Province (northern Iran).


METHODS
Patients admitted in hospitals of Guilan Province with low gradient ascites from 1993 to 2000 were enrolled in the study. Serum and ascitic fluid albumin levels were determined by biochemical reactions. The serum-ascitic albumin gradient (SAAG) less than 1.1 g/dL was considered low. Statistical analysis was performed with SPSS 9.0 software and P<0.05 was considered statistically significant.


RESULTS
Of the 148 patients enrolled in the study, 72 (48.6%) were males and 76 (51.4%) were females with a mean age of 59.03+/-13.54 years. Tuberculous peritonitis was the most frequent cause of low gradient ascites in 68 (45.9%). Other most frequent causes were cancer in 62 (41.9%), nephrotic syndrome in 9 (6%), pancreatitis in 6 (4%). Peritoneal cancer was found in 22 (35%), ovarian and gastric cancers were found in 14 (22.5%) and 12 (19.3%), respectively. All of which were the causes of ascites. The mean SAAG was 0.68+/-0.19 g/dL. The mean serum and ascitic fluid albumin concentrations were higher in tuberculous patients (P<0.006), but lactate dehydrogenase (LDH) level was higher in cancer patients (P<0.0001). In peritoneal tuberculosis, mean ascitic glucose concentration was significantly lower than other patients (P<0.0001).


CONCLUSIONS
Tuberculosis should be considered in all patients with low gradient ascites especially in developing countries (like Iran), as the first cause of ascites. In the approach to patients with low gradient ascites, ascitic fluid glucose, and LDH level are useful indicators for decision making.
Mansour-Ghanaei
Fariborz
F
Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-e-Jangle Ave, Rasht 41448-95655, Iran. ghanaei@gums.ac.ir
Shafaghi
Afshin
A
Bagherzadeh
Amir-Hossein
AH
Fallah
Mohammad-Sadegh
MS
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001201:Ascites / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology*; D001786:Blood Glucose; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D009404:Nephrotic Syndrome / Q000150:complications / Q000453:epidemiology; D010195:Pancreatitis / Q000150:complications / Q000453:epidemiology; D014395:Peritonitis, Tuberculous / Q000150:complications* / Q000453:epidemiology*; D017678:Sex Distribution
D001786:Blood Glucose; D007770:L-Lactate Dehydrogenase