ETIOLOGY OF ASCITES AND THE DIAGNOSTIC-VALUE OF SERUM-ASCITES ALBUMINGRADIENT IN NONALCOHOL LIVER-DISEASE

This study was designed to determine the different etiologies of ascit es and the diagnostic value of serum-ascites albumin gradient (SAAG) i n patients with ascites of non-alcoholic liver disease in Southern Sau di Arabia. A total of 132 patients with ascites (96 males and 36 femal es, mean age 58.8 +/- 15.9 years) were studied for the different cause s of ascites. In 55 patients with liver disease and 22 patients with n onliver disease (malignancy and peritoneal tuberculosis), we compared SAAG with the three usual parameters of ascitic fluid biochemical anal ysis used in the differential diagnoses of ascites. The nonliver disea se group showed higher ascitic fluid total protein (aTP) concentration (4.77 +/- 2.05 versus 1.98 +/- 1.56 g/dL), ascitic to serum ratio of total protein (a/sTP) concentration (0.75 +/- 0.43 versus 0.26 +/- 0.1 9), ascitic fluid lactic dehydrogenase (aLDH) level (565.4 +/- 353.4 v ersus 254.1 +/- 205.03 U/L) and a lower SAAG (0.6 +/- 0.30 versus 1.71 +/- 0.61). P<0.0001 for all parameters. The positive predictive value s for aTP, a/sTP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76%, 67%, and 80%, respectively, while the negative predict ive values were 96%, 96%, 84%, and 98%, respectively. Liver causes acc ounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephrotic syndrome 3.0%. SAAG is a useful diagnostic parameter which can be used to sepa rate ascites of liver disease (nonalcoholic) from other causes of SAAG should replace the traditional parameters (aTP, a/sTP, and aLDH) used in the differential diagnosis of ascites. In our series, liver diseas e is the major cause of ascites, followed by peritoneal tuberculosis.