Diagnostic Value of Ascitic Fluid Cholesterol Level in Differentiating Malignant Ascites from Non-Malignant Ascites

Background: Ascites, the accumulation of fluid in the peritoneal cavity, poses significant diagnostic challenges, particularly in differentiating between malignancy-related ascites (MRA) and non-malignant ascites (NMA). This differentiation is critical for appropriate clinical management. Objective: The study aimed to evaluate the diagnostic value of ascitic fluid cholesterol levels in distinguishing MRA from NMA. Methods: This cross-sectional study enrolled 48 patients with ascites, divided equally into Group A (MRA) and Group B (NMA). Diagnostic paracentesis was performed, and 20 ml of ascitic fluid was collected for analysis. Cholesterol levels were measured using the Zaks method. Demographic data were recorded, and statistical analysis was conducted using the Mann-Whitney U-test, with a p-value of 0.05 set for statistical significance. Results: Both groups had an equal gender distribution (12 males and 12 females in each), and the mean ages were 60.3 ± 19.1 years for Group A and 60.8 ± 17.9 years for Group B. The mean cholesterol level in ascitic fluid was significantly higher in Group B (189.9 ± 29.9 mg%) compared to Group A (167.73 ± 26.87 mg%), with mean standard deviations of 91.8 ± 12.4 and 20.4 ± 9.1, respectively. The p-values for gender distribution and age differences were <0.001. Conclusion: The study demonstrated that cholesterol levels in ascitic fluid are a reliable biomarker for differentiating between MRA and NMA. Higher cholesterol levels were associated with non-malignant cases, offering a non-invasive, cost-effective diagnostic tool in clinical settings.