Abstract
The serumascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A>1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with rightsided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A>1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Boyer TD, Kahn AM, Reynolds TB: Diagnostic value of ascitic fluid lactic dehydrogenase, protein, and WBC levels. Arch Intern Med 138:1103–1105, 1978
Foor AG, Youngberg GE, Westmore V: The chemistry and cytology of serous fluids. J Lab Clin Med 14:417–427, 1929
Paddock FK: The diagnostic significance of serous fluids in disease. N Engl J Med 223:1010–1015, 1940
Rovelstad RA, Bartholomew LG, Cain JC, McKenzie BF, Soule EH: The value of examination of ascitic fluid and blood for lipids and for proteins by electrophoresis. Gastroenterology 34:436–450, 1958
Spak I: On the clinical value of chemical analysis of ascites: A study of the main proteins and some enzymes in ascites of different etiology. Acta Chir Scand 261:7–13, 1960
Hoefs JC: Serum protein concentration and portal pressure determine the ascites fluid protein concentration in patients with chronic liver disease. J Lab Clin Med 102:260–273, 1983
Pare P, Talbot J, Hoefis JC: Serum-ascites albumin concentration gradient: A physiological approach to the differential diagnosis of ascites. Gastroenterology 85:240, 1983
Rector W, Reynolds T: Superiority of the serum-ascites albumin difference over ascites total protein concentration in separation of “transudative” and “exudative” ascites. Am J Med 44:83–85, 1984
Galen RS, Gambino SR: Beyond Normality—The Predictive Value and Efficiency of Medical Diagnosis. New York, John Wiley & Sons, 1975
Danilewitz M, Barbezat GO, Helman CA, Bank S: Myxedema presenting with ascites. S Afr Med J 52:895–896, 1977
Clancey R, Mackay I: Myxedematous ascites. Med J Aust 2:415–416, 1970
Kocen RS, Atkinson M: Ascites in hypothyroidism. Lancet 1:527–530, 1963
Starling EH: On the absorption of fluids from the connective tissue spaces. J Physiol 198:213–242, 1985
Sampliner ME, Iber FL: High protein ascites in patients with uncomplicated hepatic cirrhosis. Am J Med Sci 267:275–279, 1974
Witte CI, Witte MH, Dumont AE: Protein content in lymph and edema fluids in congestive heart failure. Circulation 40:623–630, 1969
Lindsay KL, Reynolds TB, Hoefs JC, Sanmarco ME: Ascites—University of Southern California and Rancho Los Amigos Hospital, Downey, California (Specialty Conference). West J Med 134:414–423, 1981
Hoefs JC: The mechanism of ascitic fluid protein concentration increase during diuresis in patients with chronic liver disease. Am J Gastroenterol 76:423–431, 1981
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mauer, K., Manzione, N.C. Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites. Digest Dis Sci 33, 1208–1212 (1988). https://doi.org/10.1007/BF01536667
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01536667