Usefulness of Serum Ascites Cholesterol Gradient (sacg), Total Protein (tp) Ratio and Serum Ascites Albumin Gradient (saag) in Differentiating Tuberculous Ascites and Cirrhotic Ascites

Background: Differential diagnosis of ascites is a common clinical problem and is usually done by Serum Ascites Albumin Gradient (SAAG).However many other markers can also be utilized for the same. Aims & Objective: This study was carried out to evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) , Total protein Ratio and serum ascites cholesterol gradient (Chol gradient/ SACG) in differentiating cirrhotic and tuberculous ascites. Material and Methods: The study included 48 patients admitted in St John’s Medical Hospital, Bangalore, out of which 25 patients were diagnosed with tuberculous ascites and 23 patients were diagnosed with cirrhotic ascites. Serum and ascitic fluid (AF) albumin, Total protein (TP) and Cholesterol (Chol) were estimated. The SAAG, TP ratio, Serum ascites cholesterol gradient (SACG) were calculated. Significance was assessed at 5% level of significance. Cohen’s d effect size has been computed and discrimination function analysis is done to determine the percentage of correct classification between cirrhotic and tubercular ascites. Results: SAAG showed a sensitivity and specificity of 100% and 95.6% at cut off of >1.1g/dl TP ratio at a cut off > 0.5 showed sensitivity100% and specificity98% specificity. Ascitic fluid Cholesterol is high in the tuberculous group and showed sensitivity and specificity of at a cut off value of 100% and 95.5%. Ascitic fluid TP showed a sensitivity and specificity of 100% and 96% at a cut off value of <2.5g/dl. Whereas SACG at a cut off value of <95mg% showed a sensitivity and specificity of 68% and 100 % respectively. Their effect sizes were (3.18, 4.21, 3.21, 3.51, 1.00 respectively). Their % discriminations were (100%, 97.9%, 95.8%, 97.9%, 60.4%). Conclusion: We conclude that SAAG is definitely the best marker along with TP ratio and AF cholesterol. However SACG is not a good marker to differentiate tuberculous ascites and cirrhotic ascites. Key-Words: Serum Ascites Albumin Gradient (SAAG); Serum Ascites Cholesterol Gradient (SACG); Total Protein (TP) Ratio; Cirrhotic Ascites; Tuberculous Ascites