Study the usefulness of ascitic fluid cholesterol level in diagnosis of malignant related ascites

Background: The differential diagnosis of ascites is a common clinical problem. However, the capability to distinguish malignant from non-malignant causes of ascites using available biochemical techniques would obviate many expensive and time-consuming diagnostic studies on patients presenting with ascites of unknown etiology. Therefore, this study was planned to evaluate usefulness of ascitic fluid cholesterol level in diagnosis of malignant ascites.Methods: Author conducted an observational study in 80 patients, those admitted and willing to give consent in the department of Medicine, LLR and Associated Hospitals, GSVM Medical College, Kanpur from December 2015 to October 2017. All patient underwent full investigations to make the diagnosis of ascites malignant (20) and non-malignant (n=54), tubercular (7) and non-tubercular (47) groups. Six patients were excluded because the ascitic fluid analysis was suggestive of bacterial peritonitis. The data was processed in MS Excel and analysis was carried out using SPSS (23th version).Results: Author found that the mean value of ascitic fluid cholesterol in malignant group was 100.85+34.28 vs 6.7+2.5 in non-malignant group (p value <0.01) and the mean value of ascitic fluid cholesterol in malignant group was 100.80+34.28 vs 32.43+15.7 in tubercular group, so ascitic fluid cholesterol is highly specific (100%) and sensitive (65%) at cut off value of 100mg/dl in differentiating benign and malignant cause of ascites.Conclusions: Ascitic fluid cholesterol having high specificity, can be used for differentiating between non-malignant and malignant ascites. It can also be used to differentiate tubercular ascites from malignant ascites.