[Diagnostic of ascites due to portal hypertension: accuracy of the serum-ascites albumin gradient and protein analises in ascitic fluid].
OBJECTIVE
To evaluate the diagnostic accuracy of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension.


METHODS
it was an observational and retrospective study of validation of diagnostic tests. The study population was patients from a National Public Health Hospital Daniel Alcides Carrion of Callao, Peru, during the period January to December of 2012, patients over 15 years old with a diagnosis of ascites which samples were taken for study by paracentesis with an standard technique, it was analyzed total protein and albumin, as well as study of total protein and albumin in blood. We obtained the diagnostic accuracy, sensitivity, specificity, PPV and NPV of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension. To determine ascites by HTP as diagnostic tests we took into account: GASA >= 1.1, PTLA <2.5, CAA <1.1 or IPAS< 0.5.


RESULTS
There were 126 patients diagnosed with ascites, 10 patients was excluded for having incomplete data. Of the 116 patients, the average age was 53.03 +/- 15.73 years old, male 65 (56%) and female 51 (44%). 61 (52%) had ascites due to portal hypertension from liver cirrhosis, and 55 (48%) of ascites due to NO HTP. The sensitivity and specificity for GASA was 93% and 47% respectively, for PTLA was 80% and 89% respectively, for CAA was 85% and 87% respectively and for the IPAS was 83% and 80% respectively. The área under the ROC curve for GASA was 0.70, ATPL was 0.84, IPAS was 0.81 and CAA was 0.86, we found statistically significant differences between GASA compared to the other three parameters (p<0.01 ).


CONCLUSIONS
The diagnostic accuracy of CAA, ATPL and IPAS is higher than the GASA to discriminate between ascites due to HTP or NO HTP, so that they could be used in clinical practice alone or together to achieve a diagnostic approach more successful.
Hospital Daniel Alcides Carrión. Callao, Perú.
Brainy Omar
BO
Rodríguez Vargas
Hospital Daniel Alcides Carrión. Callao, Perú.
Eduardo
E
Monge Salgado
Hospital Daniel Alcides Carrión. Callao, Perú.
Pedro
P
Montes Teves
Hospital Daniel Alcides Carrión. Callao, Perú.
Sonia
S
Salazar Ventura
Hospital Edgardo Rebagliati Martins. Lima, Perú.
Edson
E
Guzmán Calderón
D000418:Albumins / Q000032:analysis*; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D001202:Ascitic Fluid / Q000737:chemistry*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011506:Proteins / Q000032:analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis*
D000418:Albumins; D011506:Proteins; D012709:Serum Albumin