Serum-ascites albumin gradient in differential diagnosis of ascites

The present study was aimed to find out causes of ascites based on serum-ascites albumin gradient (SAAG) and to compare the diagnostic accuracy of the serum-ascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites and to evaluate the value of serum-ascites albumin gradient in differential diagnosis of ascites. This study includes 50 patients with ascites admitted in Medicine wards of Comilla Medical College Hospital, Comilla during the period of July 2010 to June 2011. Blood was drawn from the antecubital vein and ascetic fluid was obtained by paracentesis at the same time. Determination of the concentrations of albumin in both the serum and the ascitic fluid was carried out simultaneously. Considering SAAG value of ≥1.1g/dl is high SAAG and a SAAG value <1.1g/dl is low SAAG. Out of 50 patients, male patients were 36 and female patients were 14. Male and female ratio was 2.5:1. Age range was 21 years to 70 years. Most of the patients fall in age group of 41-50(28%).Among the 50 patients with ascites, cirrhosis of liver accounted for 68%, followed by tubercular peritonitis 12%, nephrotic syndrome 8%, congestive cardiac failure 6%, hepatocellular carcinoma 4% and malignancy related 2%. In this study serum ascites albumin gradient accurately identified the cause of ascites in 97% cases. In contrast the exudate-transudate concept identified only 83% correctly. Serum ascites albumin gradient was found superior to the exudate-transudate concept. So, differential diagnosis of ascites should be based on the serum ascites albumin gradient which is a better distinguishing marker.