Chandra Sekhar Kondapalli 1 , Aswini Devadi
BACKGROUND The Ascitic Fluid Total Protein Concentration (AFTP) has been used to classify samples into broad categories of “Transudate” or “Exudate.” The aim of this study is to compare the diagnostic value of Serum Ascites Albumin Gradient and the Ascitic Fluid Total Protein concentration in separating exudative and transudative causes of ascites and to study the value of Serum Ascites Albumin Gradient in separation of ascites related to Portal hypertension from ascites not related to Portal hypertension. MATERIALS AND METHODS Place of Study- Katuri Medical College and Hospital, Guntur. Study Design- Descriptive Study. Period of Study- Nov 2014 - Oct 2016. Study Population- Hospitalised children of Katuri Medical College, Guntur, in the age group of 1 month to 12 years who are clinically diagnosed as having ascites. RESULTS Of the patients studied, 52% cases were females and 48% cases were males. Highest number of cases were due to Nephrotic syndrome (38%) followed by Cirrhosis of liver (22%), Tuberculous ascites (20%) and Cardiac ascites (16%). Ascitic fluid total protein (AFTP) at a cut-off of 2.5 g/dL had a Sensitivity of 82.5%, Specificity of 60%, Positive predictive value of 89.2%, Negative predictive value of 46.2% and Accuracy of 78% in classifying ascites as ‘Transudate’ or ‘Exudate.’ Serum Ascites Albumin Gradient (SAAG) of 1.1 g/dL had a Sensitivity of 47.5%, Specificity of 80%, Positive predictive value of 90.5%, Negative predictive value of 27.6% and Accuracy of 54% in classifying ascites as ‘Transudate’ or ‘Exudate.’ Serum Ascites Albumin Gradient (SAAG) at 1.1 g/dL had a Sensitivity of 100%, Specificity of 93.5%, Positive predictive value of 90.5%, Negative predictive value of 100% and Accuracy of 96% in classifying ascites as ‘High gradient’ (due to Portal hypertension) or ‘Low gradient’ (non-Portal) hypertensive conditions. The accuracy of ascitic fluid total protein (AFTP) at 2.5 g/dL was 100% in diagnosing Nephrotic syndrome, 63.6% in Cirrhosis, 60% in Tuberculous ascites and 62.5% in Cardiac ascites when classifying as transudates and exudates. The accuracy of serum ascites albumin gradient at 1.1 g/dL was 100% in Nephrotic syndrome, 100% in Cirrhotic ascites, 80% in Tuberculous ascites and 100% in Cardiac ascites when classifying as High gradient and Low gradient ascites. CONCLUSION Serum Ascites albumin gradient is found to be superior to ascitic fluid total protein in the diagnosis of ascites and recommended for classification of ascites as ‘High-gradient’ or ‘Low-gradient’ ascites instead of ‘Transudative’ or ‘Exudative’ ascites. SAAG is superior to transudate-exudate concept, not only because of its high diagnostic accuracy but also because of it being a better approach to the pathogenesis of ascitic fluid collection.
