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. 2022 Nov;50(11):3000605221140310.
doi: 10.1177/03000605221140310.

Diagnostic accuracy of serum ascites albumin gradient (SAAG) in a contemporary unselected medical cohort

Mohsan Subhani  1   2 , Abhishek Sheth  1   2 , Naaventhan Palaniyappan  1   2 , Peuish Sugathan  2 , Emilie A Wilkes  1   2 , Guruprasad P Aithal  1   2
Affiliations

Diagnostic accuracy of serum ascites albumin gradient (SAAG) in a contemporary unselected medical cohort

Mohsan Subhani et al. J Int Med Res. 2022 Nov.

Abstract

Objectives: To describe the different aetiologies of ascites and test the validity of serum ascites albumin gradient (SAAG) and cytology in a contemporary unselected medical cohort.

Methods: All adult patients admitted to Nottingham University Hospitals, UK, between 1 May 2013 and 30 April 2018 with new-onset radiologically-confirmed ascites were included. Data were analysed to determine the distribution of different aetiologies of ascites and the diagnostic accuracy of SAAG in portal hypertension and cytology in malignancy as underlying causes of ascites.

Results: Over 5 years, 286 patients presented with new-onset ascites; 122 surgical cases were excluded. Most patients were men (n = 84, 51.2%) over 50 years of age (n = 142, 86.6%). Cirrhosis accounted for 54.9% (n = 90) of the cases of ascites followed by malignancy (n = 48, 29.3%) and cardiac failure (n = 10, 6.1%). SAAG ≥11 g/L had a sensitivity of 85.5% and specificity of 60.6% for diagnosing portal hypertension as a cause of ascites (diagnostic accuracy = 78.5%, 95% confidence interval (CI): 69.8-85.5; area under the curve (AUC) = 0.756, 95% CI: 0.652-0.860). Ascitic fluid cytology was positive in 50% of malignant cases and 66% of primary peritoneal carcinomatosis cases.

Conclusion: The underlying aetiology and the validity of available tests varied substantially compared with previous reports.

Keywords: Ascites; cirrhosis; contemporary cohort; cytology; liver disease; retrospective; serum ascites albumin gradient.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Receiver operating characteristic (ROC) curve diagnostic accuracy of serum ascites albumin gradient in portal hypertension.
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References

    1. Moore KP, Aithal GP. BSG Guidelines on the management of ascites in cirrhosis. Gut 2006; 55: vi1–vi12. doi: 10.1136/gut.2006.099580. - PMC - PubMed
    1. European Association for the Study of the Liver. Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69: 406–460. doi: 10.1016/j.jhep.2018.03.024. - PubMed
    1. Runyon BA, Montano AA, Akriviadis EA, et al.. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992; 117: 215–220. doi: 10.7326/0003-4819-117-3-215. - PubMed
    1. Al-Knawy BA. Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease. Ann Saudi Med 1997; 17: 26–28. doi: 10.5144/0256-4947.1997.26. - PubMed
    1. D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: 217–231. doi: 10.1016/j.jhep.2005.10.013. - PubMed

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