PORTAL DECOMPRESSION BY TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTAND CHANGES IN SERUM-ASCITES ALBUMIN GRADIENT

The serum ascites albumin gradient (SAAG) is widely used to help deter mine the cause of ascites formation. A serum ascites albumin gradient of greater than or equal to 1.1 g/dL reliably distinguishes portal hyp ertension-related ascites from other causes. To date, there are no pub lished data on the impact of portal decompression on this gradient. Th e recent development of transjugular intrahepatic portosystemic shunt (TIPS) allows for nonsurgical decompression of portal hypertension by radiologically creating a portosystemic shunt. This study examines the short-term impact of portal decompression on the serum ascites albumi n gradient (SAAG) in patients with portal hypertension-related ascites undergoing transjugular intrahepatic portosystemic shunt. Portal pres sure measurements were obtained before and after TIPS placement. Serum ascites albumin gradient was determined before and at 6 and 24 hours post-TIPS placement. Fifteen patients were enrolled in the study. The mean portosystemic gradient (PSG) before TIPS was 21.0 +/- 9.2 mmHg, w hereas the post-TIPS mean PSG was reduced to 11.0 +/- 6.3 mmHg, consis tent with portal decompression (p = 0.005). The mean pre-TIPS serum as cites albumin gradient was 1.9 +/- 0.5 g/dL and was reduced to 1.7 +/- 0.5 g/dL at 6 hours (p = 0.003) and 1.4 +/- 0.4 g/dL at 24 hours (p = 0.002) after TIPS placement. These findings further solidify the asso ciation between the SAAG and portal hypertension.