Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites

Context. Ability of SAAG to diferentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for diferentiating ascites due to malignancy from those due to tubercular peritonitis. Aims. To study the diagnostic utility of serum ascites lipid gradients and serum ascites protein gradients in pathophysiological diferentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material.Te study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. Te study included 60 patients with ascites of diferent etiologies (liver cirrhosis, tubercular peritonitis, and malignant ascites). All of them had undergone clinical, laboratory, and imaging investigations and were treated as per standard of care. All patients underwent abdominal paracentesis, and fuid samples were sent for analysis. Statistical Analysis Used. ANOVA, KruskalWallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical signifcance (<0.005) among the groups, but no signifcance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fuid parameters measured had an overall statistical signifcance (<0.005), but there was no signifcant diference observed between malignancy and tubercular peritonitis groups. However, ascitic fuid and serum HDL cholesterol had a statistical signifcance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-of value of 4, SAPG is one of best screening tests in diferentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specifcity in diferentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fuid to be a valuable marker with higher sensitivity and specifcity in diferentiation of malignancy and tuberculosis peritonitis (i.e., diferentiation of low SAAG ascites).