Clinical Value of Serum-Ascites Albumin Gradient and Ascitic Fluid Ferritin Concentration in Differential Diagnosis of Ascites

Kim, Doe Young; Jung, Hye Kyung; Yi, Sun Young; Moon, Li Hwun

Abstract

BACKGROUND AND AIMS: The differential diagnosis of ascites is very important because correct diagnosis leads to adequate treatment plan and prognosis. A difference of more than 1.1 g/dL between the concentration of albumin in serum and ascitic fluid (serum-ascite albumin gradient; SAAG) has been reported to be a more superior index than transudate ascites for reflecting portal hypertension and differentiating benign ascites from malignant ascites. On the other hand, serum ferritin levels are often elevated in pateints with certain tumors and the ascitic fluid ferritin was found to be a reliable indicator of malignant ascites, and it is particulary helpful in distinguishing cirrhotic ascites from ascites associated with primary or metastatic liver disease. But correlation of SAAG and malignant ascites was poor in some reports and ascitic ferritin concentration has not been measured yet in Korea. So this study was designed for detection of diagnostic values of SAAG and ascitic fluid ferritin concentration for the differentiation of ascites.
METHODS
Thirty one patients with ascites was studied by diagnostic paracentesis. The underlying diseases were 15 cases of cirrosis and 9 cases of hepatocellular carcinoma (HCC) and 7 cases of carconimatosis peritonei. The SAAG and ascitic fluid ferritin concentration were measured to evaluate the accuracy in the differential diagnosis of ascites.
RESULTS
The measured SAAG were 2.0+/-0.6 g/dL in cirrhosis group, 1.8+/-0.5 g/dL in HCC and 1.0+/-0.3 g/dL in carcinomatosis peritonei. SAAG showed significant difference between liver disease-related ascites such as liver cirrhosis, HCC and peritoneal disease-associated ascites such as carcinornatosis peritonei (p<0.05). The ascitic fluid ferritin were 255.1+/-292.1 ng/ml in cirrhosis, 608.4+/-380.0 ng/ml in HCC, 476.6+/- 613.4 ng/ml in carcinomatosis peritonei, so the ascitic fluid ferritin tended to be higher in HCC than liver cirrhosis.
CONCLUSIONS
The SAAG is a sensitive methnd to differentiate the liver disease-related ascites and peritoneal disease-associated ascites, and the ascitic fluid ferritin is suggested as a useful method to differentiation hepatocellular carcinoma from cirrhosis.