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Ascitic fluid protein of greater than 2.5 gm per cent in hepatic cirrhosis is usually interpreted as evidence of a superimposed neoplastic or infectious process. Two years' experience of the Lemuel Shattuck Hospital Clinical Laboratory were reviewed for patients with uncomplicated hepatic c

The serum-ascites albumin difference, an index of the serum-ascites oncotic pressure difference, correlates directly with the pressure gradient between the portal capillaries and the peritoneal cavity. This test was compared with the ascites total protein concentration in the separation of "transudative" and "exudative" ascites. The serum-ascites albumin difference was large in patients with transudative ascites (1.6 +/- 0.5 g/dl) and small in patients with exudative ascites (0.6 +/- 0.4 g/dl, p less than 0.001) and provided significantly better discrimination of these categories than did the ascites total protein concentration. The serum-ascites albumin difference was especially useful in the separation of cardiac ascites, which usually has a high total protein concentration, from high protein exudative ascites. The serum-ascites albumin difference did not provide perfect discrimination of any category, however; in patients with mixed causes of ascites, this difference tended to be large, resembling ordinary transudative ascites, a potential source of diagnostic error. Nevertheless, the serum-ascites albumin difference has superior discriminatory power and should replace the ascites total protein concentration in the routine diagnostic examination of ascites.

Serum ascites albumin gradient (SAAG) has been recognized as a reliable marker in the differential diagnosis of ascites. The etiological background of cirrhosis is rather different between western countries and eastern countries. The threshold of SAAG in Chinese ascitic patients has not been evaluated yet. The aim of this study was to define a new reasonable threshold of SAAG in Chinese ascitic patients. Adult patients with ascites admitted to the Shanghai Changzheng Hospital from Jan 2004 to Jun 2010 were retrospectively analyzed. The diagnostic criteria for cirrhotic ascites are clinical manifestations, radiological features and esophageal-gastric varicosis, or histopathology. Serum was detected by chemical method using a commercial kit. We used receiver operating characteristic (ROC) analysis to achieve maximal sensitivity and specificity of SAAG. The mean value of SAAG in portal-hypertension-related ascites was significantly higher than that in the non-portal-hypertension-related ascites (21.15 ± 4.38 g/L vs 7.48 ± 3.64 g/L, P = 0.002). The SAAG cut-off value under 12.50 g/L predicted portal hypertension ascites with the sensitivity of 99.20%, specificity of 95.10% and accuracy of 97.65%. SAAG is useful to distinguish portal-hypertension-related ascites and non-portal-hypertension-related ascites, and 12.50 g/L might present as a more reasonable threshold in Chinese ascitic patients. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1602582638991860

Three characteristics of an exudate, ie, an ascitic fluid lactic dehydrogenase (LDH) level of > 400 Sigma units (SU), an ascitic fluid-serum LDH ratio of > 0.6, and an ascitic fluid-serum protein ratio of > 0.5, were studied in a prospective fashion to determine their usefulness in the differential diagnosis of ascites. The ascitic fluid LDH level did not exceed 400 SU in any patient with uncomplicated chronic liver disease, whereas in patients with malignant, tuberculous, or pancreatic ascites it exceeded 500 SU in 12/19 patients. The finding of two of the three characteristics indicated a nonhepatic cause for the ascites whereas the absence of all three strongly suggested uncomplicated liver disease as the sole cause. The ascitic fluid WBC count was also useful in that values exceeded 500/cu mm in bacterial and tuberculous peritonitis whereas it was low (297 ± 49/cu mm) in chronic liver disease. ( Arch Intern Med 138:1103-1105, 1978)