Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites
Context. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating ascites due to malignancy from those due to tubercular peritonitis. Aims. To study the diagnostic utility of serum...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | International Journal of Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2019/8546010 |
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| author | Mukhyaprana Prabhu Rahul Sai Gangula Weena Stanley |
| author_facet | Mukhyaprana Prabhu Rahul Sai Gangula Weena Stanley |
| author_sort | Mukhyaprana Prabhu |
| collection | DOAJ |
| description | Context. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating 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 differentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material. The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different 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 fluid samples were sent for analysis. Statistical Analysis Used. ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites). |
| format | Article |
| id | doaj-art-8800531571a5493aad99a4be01924b60 |
| institution | Kabale University |
| issn | 2090-3448 2090-3456 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Hepatology |
| spelling | doaj-art-8800531571a5493aad99a4be01924b602025-02-03T01:10:20ZengWileyInternational Journal of Hepatology2090-34482090-34562019-01-01201910.1155/2019/85460108546010Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of AscitesMukhyaprana Prabhu0Rahul Sai Gangula1Weena Stanley2Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, IndiaDepartment of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, IndiaDepartment of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, IndiaContext. Ability of SAAG to differentiate malignant ascites from other aetiologies like tubercular peritonitis is a major problem. Alternate screening test is needed for differentiating 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 differentiation of ascites. Settings and Design. The present study is a prospective, descriptive, hospital-based, cross-sectional study. Methods and Material. The study was conducted on patients with ascites who were admitted to General Medicine Department, Kasturba Hospital, Manipal. The study included 60 patients with ascites of different 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 fluid samples were sent for analysis. Statistical Analysis Used. ANOVA, Kruskal-Wallis H test, and ROC curve analysis. Results. Among the gradients, only SAPG and SAAG had over all statistical significance (<0.005) among the groups, but no significance between malignancy and tubercular peritonitis had been observed. Similarly all the ascitic fluid parameters measured had an overall statistical significance (<0.005), but there was no significant difference observed between malignancy and tubercular peritonitis groups. However, ascitic fluid and serum HDL cholesterol had a statistical significance (<0.05) between malignancy and tubercular peritonitis. Conclusions. With a cut-off value of 4, SAPG is one of best screening tests in differentiation of cirrhotic with noncirrhotic ascites when compared with SAAG, whereas it is a poor parameter with high sensitivity and very low specificity in differentiation of malignant with nonmalignant ascites. Also the present study reveals HDL cholesterol levels in ascitic fluid to be a valuable marker with higher sensitivity and specificity in differentiation of malignancy and tuberculosis peritonitis (i.e., differentiation of low SAAG ascites).http://dx.doi.org/10.1155/2019/8546010 |
| spellingShingle | Mukhyaprana Prabhu Rahul Sai Gangula Weena Stanley Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites International Journal of Hepatology |
| title | Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites |
| title_full | Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites |
| title_fullStr | Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites |
| title_full_unstemmed | Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites |
| title_short | Diagnostic Utility of Serum Ascites Lipid and Protein Gradients in Differentiation of Ascites |
| title_sort | diagnostic utility of serum ascites lipid and protein gradients in differentiation of ascites |
| url | http://dx.doi.org/10.1155/2019/8546010 |
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