[Etiologic and laboratory analyses of ascites in patients who underwent diagnostic paracentesis].
OBJECTIVE
Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests.


METHODS
Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses.


RESULTS
The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%.


CONCLUSIONS
Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes.
Hwangbo
Young
Y
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Jung
Ji Heon
JH
Shim
Jaejoon
J
Kim
Byung Ho
BH
Jung
Sung Hoon
SH
Lee
Chang Kyun
CK
Jang
Jae Young
JY
Dong
Seok Ho
SH
Kim
Hyo Jong
HJ
Chang
Young Woon
YW
Chang
Rin
R
D000243:Adenosine Deaminase / Q000032:analysis; D000328:Adult; D000368:Aged; D001202:Ascitic Fluid / Q000737:chemistry / Q000473:pathology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019152:Paracentesis; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies
D000243:Adenosine Deaminase