Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

Abstract

Context. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. Aims. To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological differentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material. The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fluid samples were sent for analysis. Statistical Analysis Used. ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).

Diagnostic utility of the serum–ascites albumin gradient in Mexican patients with ascites related to portal hypertension

“…Prabhu et al . studied 60 patients 25 and showed that SAAG had a sensitivity of 90% and specificity of 77.5% in differentiating cirrhotic from noncirrhotic ascites at a cutoff value of >1.1 g/dL, whereas it had a sensitivity of 85% and specificity of 70% in the differentiation of malignant from nonmalignant ascites at a cutoff value of 1.08 g/dL. The AFA levels had a sensitivity of 90% and specificity of 72.5% in differentiating malignant from nonmalignant ascites, at a cutoff value of >1.7 g/dL, whereas at a cutoff value of 0.8 g/dL, its sensitivity was 90% and specificity 90% for differentiating cirrhotic from noncirrhotic ascites.…”

Personalized diagnostic approach and indirect quantification of extravasation in human anaphylaxis

“…Results obtained showed a decrease in both factors during the acute phase compared to baseline and according to the severity of the reaction. Serum protein concentration has been proposed as a diagnostic indicator for other acute conditions such as pancreatitis and ascites 17,18 . Similarly occurs with HSA, where a decrease in its levels has been related to several pathological processes like operative stress and liver surgery 19,20 .…”

“…Precisely, both determinations have been proposed as molecular markers for several pathological conditions. [17][18][19][20] However, most findings on the leakage of vascular fluids associated with anaphylaxis have been obtained from animal models and barely in the context of patients. 10 In particular, a study based in haemoglobin measurements demonstrated that a transfer of up to 35% of plasma to the interstitial compartment can occur in the first 10 min of the reaction in patients with anaphylaxis.…”

“…Therefore, measurements of protein concentration and HSA levels could be used to indirectly quantify the extravasation underlying anaphylaxis. Precisely, both determinations have been proposed as molecular markers for several pathological conditions 17–20 …”

“…Precisely, both determinations have been proposed as molecular markers for several pathological conditions. 17 , 18 , 19 , 20 …”