The Role of Serum Ascites Albumin Gradient in the Differential Diagnosis of Ascites.

Introduction: Ascites is of Greek derivation (“askos”) and refers to a bag or sack. The word is a noun and describes pathologic fluid accumulation within the peritoneal cavity. Orientation in finding or excluding portal hypertension through examination of ascitic fluid is the first step towards an accurate diagnosis. Material and Methods: The aim of this study was to evaluate the role of SAAG (Serum Ascites Albumin Gradient) in the differential diagnosis between cirrhotic and malignant ascites. The SAAG is obtained by subtracting the value of serum albumin, the value of ascites albumin (from samples to be taken on the same day) and is a reflection of hepatic sinusoidal pressure. Result: All ascitic fluids were analyzed on the laboratory parameters of ascitic albumin values and at the same time serological albumin through the blood was taken for analysis on the same day as the diagnostic paracentesis. The value of SAAG was calculated for each patient between their two groups: 64 patients with cirrhotic ascites and 8 patients with malignant ascites. Higher SAAG values were found in the group of patients with hepatic cirrhosis (2.02 ± 0.42) compared to the group of patients with malignant pathology (0.68 ± 0.19). Conclusion: This prospective study showed statistically significant differences (p <0.0001) between cirrhotic ascites and malignant ascites in terms of SAAG, emphasizing the important role of diagnostic paracentesis and in particular the SAAG in the differential diagnosis of ascitic fluid, in accordance with cut-off values ≥1.1 g / dl referring to ascites from portal hypertension, which suggests a nonperitoneal cause of ascites.